Drug Addicted Babies, Redux
We were recently informed about organizations serving pregnant addicts that are closing due to changes in Medicaid reimbursement. In an article we posted in May 2025 we noted that Medicaid was the payor for about 84% of the treatment for these women and their newborns. This is not surprising as most of the mothers live below the poverty line either as result of or contributing to their drug use.
The public thinks of schedule 1 narcotics and schedule 2 narcotics abuse as general drug abuse, and we do not often enough think about the damage from alcohol and nicotine. Taking all of that together the National Institute for Alcoholism and Alcohol Abuse (NIAAA) estimates that 300,000 newborns every year have been exposed to one or more of those drugs in utero. When considering neonatal abstinence syndrome specifically, babies born with an addictive substance in their system, nearly 22,000 babies are born essentially in withdrawal every year.
NIAAA issued the first government health advisory to limit alcohol use during pregnancy in 1977 discussing the physical impacts of Fetal Alcohol Syndrome (FAS). Yet in 2023 between 1% and 5% of first grade children in the U.S. had an FAS diagnosis. Today FAS is the leading cause of preventable birth defects causing a wide range of physical, neurologic developmental issues and a range of physical and mental health issues that occur later in life.
In more recent years we have focused, too, on the increasing incidence of other drugs present in newborns. The primary drugs abused during pregnancy and those found in newborns 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 and
· Nicotine.
When more than one drug has been used the symptoms can be multiplied.
Where NAS is detected these infants require medicines to treat severe symptoms including seizures. 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. Yes, babies suffering the pain and potential damage from withdrawal are “detoxed” in a neonatal intensive care setting.
Regardless a diagnosis of NAS, exposure to drugs in utero often causes harm including:
· Poor growth in the uterus
· Blocking placental flow and sometimes placenta damage
· Premature birth and lack of fetal development
· Low birth weight
· Seizures
· Jaundice
· Several types of birth defects
The issues resulting and evidenced later in life directly related to poor early development are well studied. Learning disabilities, behavioral and behavioral health issues, physical difficulties through poor neurologic and skeletal development, and intellectual function issues are well documented.
Yet, we also know that developmental issues result from the environment in which these children grow up. 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, as well as direct, physical and emotional abuse by the parent themselves or by putting their children at risk of physical, emotional and sexual harm from others.
One article we cited in May 2025 found that more than 50% of mothers were HIV positive, and that 40% of mothers and 30% of fathers died shortly after birth. This results in very high incidence of foster care placement. We can certainly applaud foster care parents but there have been ample reports of abuse and neglect that too often occur in that system whose resources are taxed in large part because of this influx of children of mothers and fathers addicted to alcohol and other drugs.
As detailed in our previous article, children with a post-birth diagnosis of NAS were more than twenty 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. Attention deficit hyperactivity disorder may affect one in five of these now adolescents, and they are far more likely to use nicotine, cocaine, cannabis and to abuse alcohol in adolescence.
There are, too, less obvious but serious issues in adulthood resulting from attachment disorders, difficulty establishing trusting relationships, being overly 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.
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 that diagnosed. Although studies of the consequences to the nation as these children become adults are just beginning, the combination of neurologic and physical effects of this drug exposure, and adverse conditions of childhood and adolescence among these children suggests that 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.
There are several press reports citing addiction specialists and sophisticated analyses all assessing likely reductions to alcohol and other drug addiction treatment from recent Medicaid reductions. We have discussed previously the need for changes in the system of treatment, many of which are underway. That is no excuse for this short sighted reduction in treatment that will result in extraordinary costs immediately and as these children enter school age, adolescence and early adulthood.
Gene Gilchrist
January 2026
