What Methadone Use During Pregnancy Means for Newborns

It’s well-reported that we're currently living amid an opioid crisis: On average, 130 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention. But as we struggle to save lives that are being lost due to overdose, the complications addiction has on new lives being born is often overlooked.

In 2014, an estimated 32,000 infants were born addicted to and withdrawing from opiates, also known as neonatal abstinence syndrome (NAS), according to the latest national data from the National Institute on Drug Abuse. While the availability of Medication-Assisted Treatments (MAT), like Methadone, help pregnant people addicted to opioids avoid taking illicit drugs and dangerous withdrawals, these medically monitored treatments still come with the risks for newborns. Opioid-exposed infants can be born with a myriad of health issues that may follow them as they grow and develop.

Here's everything we know about the use of methadone in pregnant people and its effects on the next generation.

What Methadone Is and Why It's Prescribed During Pregnancy

Methadone is a long-acting opioid medication used with counseling and other necessary services to treat individuals addicted to short-acting opioid drugs like heroin and opioids,” says Christen Edwards, an obstetrics nurse educator at Northwestern Medicine McHenry Hospital. When an addict is trying to become pregnant or already pregnant, their medical team will get them on a treatment plan at the earliest possible time.

“Using methadone will help to get the pregnant mother away from using illicit drugs and onto a monitored regimen in conjunction with prenatal care, making both mother and infant safer throughout and following pregnancy,” says Edwards. “Using methadone in place of other IV drugs can also make the mother safer from other diseases such as HIV or hepatitis.”

Medical professionals choose Methadone treatment because it can prevent withdrawal symptoms that can be dangerous to both mother and fetus. “Withdrawal for pregnant women is especially dangerous because it causes the uterus to contract, and may bring on miscarriage or premature birth," says Edwards. Ultimately, people who are on a methadone treatment plan are on it to protect themselves and their unborn babies.

Methadone must be prescribed and can be obtained by prescription from methadone clinics. Medical professionals then follow patient symptoms and dosing very carefully during treatment to reach the safest balance.

How Methadone Impacts Newborns

According to the latest data, one baby was born with signs of NAS every 15 minutes. Since Methadone is an opioid medication, infants exposed to it during pregnancy can experience signs of withdrawal after birth. If withdrawal begins, the baby is likely to be given a low dose of treatment such as of morphine, buprenorphine, or methadone, and weaned off over a series of days following birth, says Jane Brumbaugh, M.D., a neonatologist at Mayo Clinic Children’s Center.

"Without continued treatment, these infants would suffer the side effects common with withdrawal, like diarrhea, stomach cramps, sweating, skin excoriation, crying, and being inconsolable,” explains Edwards. Babies who demonstrate more significant signs of withdrawal may remain in the hospital for additional treatment. These withdrawal symptoms may include disrupted sleep patterns, jittery movements, seizures, poor feeding, sneezing, fevers, and sensitivity to environmental stimuli, such as loud sounds and bright lights.

While some signs of withdrawal may persist for weeks to months after discharge, babies with NAS stay in the NICU for an average of 23 days, according to the Association of American Medical Colleges.

Mothers who are still taking methadone are able to breastfeed their new babies because the concentration of methadone in breastmilk is low and the benefits of breastfeeding outweigh the risk of exposure, according to a study published in the journal Canadian Family Physician.

Long-Term Effects of Methadone on Babies

Though few studies have been done to track the long-term impact of NAS, physical and neurological examinations have shown that children affected may face great behavioral, vision, language, and developmental problems than children not exposed to opioids before birth.

One study that evaluated children at 6 months of age found that babies exposed to methadone had delayed motor development and another longer-term study that looked at 8-year-olds born with NAS found that they had lower cognitive function and greater attention problems than non-exposed children. These children also exhibited issues with regulating their emotions such as anxiety, depression, and aggressive behavior, though the study acknowledges that further research is needed to clarify all possible factors over time.

“Children affected by NAS may qualify for multidisciplinary follow-up programs, such as neonatal intensive care nursery follow-up clinics, through early childhood age,” says Dr. Brumbaugh. “The multidisciplinary team screens children for developmental differences and supports children and their families when developmental differences are identified.”