Addicted Newborns
Exposure To Drugs In Newborns
Perhaps the most damaging, long term result of alcohol and other drug abuse for America occurs from babies exposed to addictive drugs during pregnancy and in some cases, infants born with drugs in their system. “The Conversation” reports (“Hundreds of thousands of US infants every year pay the consequences of prenatal exposure to drugs, a growing crisis particularly in rural America”, The Conversation, February 2024) that 8% of American infants were exposed to an addictive substance in utero. “Nearly 1 in 12 newborns in the United States in 2020 – or about 300,000 infants – were exposed to alcohol, opioids, marijuana or cocaine before they were born.”
We have known about Fetal Alcohol Syndrome (FAS) for a few decades, but alcohol remains by far the most common exposure. Responding to then recent publications on the original syndrome FAS, NIAAA issued the first government health advisory to limit alcohol use during pregnancy in 1977. Yet, today, according to NIAAA, (“Fetal Alcohol Spectrum Disorders”, Updated: November 2023) between 1 and 5% of first grade children have FAS. From their publication, “Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental deficits in the United States. It can cause a range of intellectual and behavioral problems, which appear at any time during childhood and last a lifetime.”
Concerning drugs other than alcohol, the American Association of Pediatrics (“An Update on the Burden of Neonatal Abstinence Syndrome in the United States “, Kamleshun Ramphul, MD Corresponding Author, Stephanie Gonzalez Mejias, MD, Jyotsnav Joynauth, MD, Brief Reports| February 2020) 32,128 or about 1% of babies born in 2023 were born with Neonatal Abstinence Syndrome (NAS). Estimates are that there are many infants with NAS not diagnosed for a variety of reasons.
The mothers were in great part living below the poverty level. In an article published in the American Journal of Maternal Health (“Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016–2020 Transformed Medicaid Statistical Information System”, Kristina D West, Mir M Ali, Martin Blanco, Brenda Natzke, Linda Nguyen, American Journal of Maternal Health, May 2023) the authors report, “Medicaid covered 83.8% of patients, and 40.2% had an income within the first quartile of national averages.” From that report the cost to the nation counting only the hospital stay include, “The overall mean and median length of stay were 16.45 and 12.00 days, respectively, and the mean and median total charges were calculated as $79,937.75 and $38,537.00, respectively. The total costs of NAS were $2,549,098.”
Stanford Hospital for Children carries a thorough report about those early hospital stays on their website (https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387#). Neonatal abstinence syndrome (NAS) occurs when babies are exposed to drugs in the womb before birth. Babies are essentially born in withdrawal.
Some drugs and medicines are more likely to cause the syndrome than others. These include:
· Opioids like heroin and fentanyl
· Prescribed medicines such as codeine and oxycodone
· Stimulants such as amphetamines or cocaine
· Antidepressant medicines such as selective serotonin reuptake inhibitors (SSRIs)
· Depressants such as barbiturates, alcohol, or marijuana
· Nicotine from cigarette smoking.
When more than one drug has been used, the symptoms are often worse.
Where NAS is detected, infants may need medicines to treat severe withdrawal symptoms such as seizures. Medicines may also help relieve the discomfort and problems of withdrawal. If medicine is needed, babies will usually be given a medicine that is in the same family of drugs as the drug the baby was exposed to before birth. After symptoms subside, the infant will be weaned off the drug.
Regardless a diagnosis of NAS, exposure to drugs in utero often causes:
· Poor growth in the uterus
· Premature birth and lack of development
· Seizures
· Jaundice
· Several types of birth defects
Specific drugs have been linked to specific problems in infants. These may include:
· Opioids, including methadone, can cause serious withdrawal in the baby. Some symptoms can last as long as 4 to 6 months. Seizures may also occur in babies born to opioid users
· Amphetamines can lead to low birth weight and premature birth
· Cocaine use can cause poor growth and can also make complications such as placental abruption more likely
· Marijuana use may cause lower birth weight as well as later learning and behavior problems.
Even without neonatal abstinence syndrome, prenatal drug exposure can be related to later developmental delay.
Other developmental issues may also be the result of the environment in which the baby grows up. One study discussing childhood and adolescent rearing environments noted several negative outcomes regardless a diagnosis of NAS (“Adult consequences of prenatal drug exposure”, Ju Lee Oei, Internal Medicine Journal, January 2018). “However, NAS is not the only problem faced by children of drug-using mothers. Many mothers with drug-using disorders use multiple drugs and have poor lifestyle issues. Parents affected by drug-use disorders may be unable to parent adequately, with parenting styles ranging from being neglectful, to being over-authoritative and inappropriate, putting their children at risk of physical, emotional and sexual harm. In Australia, more than 50% of methadone-maintained mothers’ (children) were placed into foster care by age 5. Other studies showed that children with a post-birth diagnosis of NAS were 21 times more likely to be hospitalized during childhood for assaults, injuries and maltreatment and three times more likely to die before the age of 12 than other Australian children. This all adds up to great social vulnerability and chronic stress, which in turn, potentially impairs adequate development of adult working memory, general cognitive functioning, attention and executive function.”
A previous study in the Journal of Social Work and Public Health found similar issues (“The Impact of Substance Use Disorders on Families and Children: From Theory to Practice”, Laura Lander, Janie Howsare, Marilyn Byrne, Journal of Social Work Public Health, July 2013). The study reported elevated rates of attachment disorders in part due to abuse and neglect and in part because of alcohol-related deficits in cognitive and social-emotional functioning. Further, “The negative consequences of having one or both parents with a SUD ranges from covert damage that is mild and may play out when a child or adolescent is having difficulty establishing trusting relationships with people, to being overly emotionally responsible in relationships and taking on adult roles much younger than developmentally appropriate.” There are now twelve step groups and ample research for adult children of alcoholics and addicts.
The consequences evidenced in adolescent and adult development are yet to be studied in a rigorous and controlled way. Ju Lee Oei (ibid.) discusses those long term issues in an article previously noted. Reviewing a study of heroin-exposed infants when they are adults (mean aged 22) with a postnatal diagnosis of NAS Oei notes, “More than 50% of their mothers were HIV positive and 40% of mothers and 30% of fathers died (shortly) after the birth. Almost a quarter (23%) were adopted/fostered before childhood and >25% reported emotional and physical abuse. Attention deficit hyperactivity disorder was diagnosed in 20%, 76% smoked, 5% reported hazardous drinking, 87% had used cannabis at least once and almost half (47%) had used cocaine. Half undertook post-school studies but 37% were unemployed. More than half (57%) had received psychiatric treatment during childhood.”
Although there is a recent decline in NAS it is not clear whether that is transient or the result of factors that portend further declines. Regardless, in sixteen States the incidence of NAS is greater than 2% and in five States it is greater than 5%. Estimates are that the incidence of drug exposure in utero is many times diagnosed NAS perhaps 300,000 births each year. Although studies of the consequences to the nation as these children become adults, the combination of neurologic and physical effects of this drug exposure, and adverse conditions of the childhood and adolescence among these children, suggests that the those later reviews will evidence extraordinary cost to the nation. The leading edge of the children from the increase in this maternal behavior is here today.
Gene Gilchrist
May 2025
