For pregnant women who are addicted, doctors advocate maintenance drugs over quitting altogether

  • A medical exam room in the Harbor Care Health and Wellness Center at Keystone Hall is seen in Nashua on May 2, 2016. (ELIZABETH FRANTZ / Monitor staff) Elizabeth Frantz

 Monitor staff
Published: 5/18/2016 1:54:53 AM

There is a common feeling Dr. Molly Rossignol hears from her pregnant patients who are struggling with addiction. 

“They’re incredibly ashamed and they feel like they’re terrible people,” said the addiction specialist at Concord Hospital. In addition to battling a physical and psychological dependence to opioids, expectant mothers face a serious reality – a large majority of them will pass
their drugs dependence onto their unborn child.

But Rossignol tries to frame these moments in a different way, reminding expectant moms that pregnancy is a great opportunity to make steps toward recovery.

“It’s a great time to start treating someone for addiction because clearly moms want the best for their babies,” she said. “They’re very motivated to get into care for that reason.”

The rates of babies born dependent to opioids – passed along from their mothers in the womb is growing in the midst of New Hampshire and New England’s drug epidemic.

Rates of neonatal abstinence syndrome, also known as NAS, have doubled nationally from 2009 to 2012. From 2000 to 2009, they increased five-fold in the Granite State, from 22 NAS babies to 116.

By 2014, six percent of newborns born at the Children’s Hospital at Dartmouth-Hitchcock were exposed to opioids in utero.

Withdrawal from opioids makes the babies fussier than normal and can produce near-constant crying while the drug dissipates. They can also experience symptoms like fever, diarrhea and problems eating and sleeping normally.

Rossignol said the trend is noticeable in Concord. She remembers working as an OBGYN in the hospital in the early and mid-2000s and occasionally seeing babies who needed to be weaned off drugs with morphine.

“Now, it’s right smack dab in front of us,” she said.

Like other substances including alcohol, tobacco and anti-depressants, opioids can pass through the placental barrier and be transmitted to a fetus.

Rather than encouraging the moms to quit drugs altogether, the course of treatment for pregnant women usually involves maintenance drugs like methadone or buprenorphine – two prescription opioids that reduce cravings from heroin and fentanyl and stave off the sickness that comes from opioid withdrawal.

“Really, the goal is – keep mom as stable as possible,” Rossignol said.

If moms go off methadone or buprenorphine and suddenly try to go drug free, their risk of overdosing is huge, Rossignol said.

In addition, going cold turkey later on in a pregnancy can have serious consequences for the baby.

Moms who go on maintenance drugs often still give birth to babies with NAS.

For instance, about 60 percent of babies born to moms on methadone will have NAS. However, whether the mother is on 10 milligrams of methadone or 150 milligrams doesn’t seem to have any bearing on whether the baby will be born dependent on the drug, Rossignol said.

Researchers are studying whether the genes of individual babies also play a part in whether or not they develop NAS.

The silver lining about neonatal abstinence syndrome is that it’s curable, said Dr. Alison Holmes, a pediatrician at the Children’s Hospital at Dartmouth.

Holmes and her colleagues published a study showing a simple remedy to help many babies with NAS – keeping them in the same hospital rooms as their mothers rather than separating them into a neonatal intensive care unit.

“Rooming in affects the babies because they can be in a calm environment where they can spend a lot of time skin to skin with their mother or another family member,” Holmes said.

Researchers at Dartmouth-Hitchcock conducted the study from 2013 to 2015. Their results showed that keeping NAS newborns in the same hospital room as their mother decreased the total number that needed morphine to deal with withdrawal from 46 percent to 27 percent, shaved an average of about 4.5 days off the babies’ hospital stay and lowered the cost of treatment per infant from $19,737 to $8,755.

The researchers tried to keep the babies with their mothers whenever possible, only transferring babies to the hospital’s neonatal intensive care unit if they were born prematurely or suffering from other illnesses in addition to being in withdrawal.

Holmes says the research is important because it shows that a calming, quiet environment and skin-to-skin contact with family members is just as important as intensive care in a hospital.

Rossignol said a big part of caring for addicted mothers and their babies is reducing the same stigma around drug abuse that is the reason so many of the moms she sees feel ashamed.

“We have to remember moms do not want to hurt their babies,” she said. “She wants the best for her baby, she wants the best for herself.”

(Ella Nilsen can be reached at 369-3322 or enilsen@cmonitor.com.)




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