Fentanyl While Pregnant: What You Need to Know

During pregnancy, it is important to monitor what you put in your body. Pregnant women are often cognizant of what they eat, which medications they use and how much of these medications they take. When used as instructed, painkillers are generally safe when taken to treat chronic pain during pregnancy. However, opioids like Vicodin are habit-forming drugs that can lead to misuse and addiction. Misusing painkillers at any stage of pregnancy can harm the mother and her fetus.

Fentanyl is a highly addictive opioid that can be particularly dangerous when used during pregnancy. An unborn child exposed to this drug can experience neonatal abstinence syndrome (NAS) upon delivery, a condition characterized by the presence of painful drug withdrawal symptoms in newborns.

In recent years, the disorder has become increasingly problematic in the United States. According to the Centers for Disease Control and Prevention, the incidence of NAS rose by 383 percent from 2000 to 2012. Prenatal use of fentanyl can increase a baby’s risk for developing this disorder.

Fentanyl While Pregnant
Derived from the poppy plant, fentanyl is a synthetic opioid used in medical settings to treat moderate to severe pain. Often prescribed to patients after surgery or during cancer treatment, fentanyl typically comes in the form of a liquid solution, lozenges or transdermal patches. The drug is often used to mitigate pain during labor.

However, the opioid has been increasingly misused for its numbing and euphoric properties. Fentanyl has dangerous side effects that include confusion, sedation, respiratory depression, unconsciousness, and coma. Taking too much of the substance can cause a fatal overdose.

Fentanyl is one of the most powerful opioids in the world. According to the Drug Enforcement Administration, the drug is 30 to 50 times more potent than heroin and 50 to 100 times more potent than morphine. Just two milligrams of fentanyl, equivalent to a few grains of table salt, can be lethal.

Fentanyl use has exacerbated the opioid epidemic in the United States. In 2017, according to the Centers for Disease Control and Prevention, about 28,466 Americans died from overdoses involving synthetic opioids other than methadone, which includes fentanyl. The rate of overdoses involving synthetic opioids other than methadone doubled from 2015 to 2016.

Using fentanyl while pregnant can lead to a host of health problems in your baby. It can cause preterm labor or premature birth, fetal growth restriction, low birth weight, heart defects, spina bifida or miscarriage.

NAS is a common outcome of using fentanyl during pregnancy. According to the National Institute on Drug Abuse, a baby is born dependent on opioids every 25 minutes. The symptoms of neonatal abstinence syndrome vary depending on the type of drug used, the last time it was used and whether the baby is born premature or full-term.

Babies withdrawing from fentanyl will likely endure more painful withdrawal symptoms than newborns withdrawing from less powerful opioids like heroin, OxyContin, morphine, and hydrocodone.

Opioids like fentanyl can cause health problems in newborns, including:

  • Vomiting
  • Diarrhea
  • Sweating
  • High-pitched crying
  • Trembling
  • Sleep problems
  • Fever
  • Poor feeding
  • Seizures

A 1994 study published in the Journal of Pediatric Nursing examined withdrawal symptoms in critically ill babies who received continuous infusions of fentanyl. Among 12 pediatric intensive care infants, six met the criteria for NAS. The newborns with NAS often experienced insomnia, increased muscle tone, tremors, and increased respiratory rate. Please note: the study utilized a small sample size, so results may not be easily extrapolated to the general public.

Symptoms of NAS often begin 1 to 3 days after birth, according to the U.S. National Library of Medicine. However, they could take up to a week to appear. Because the condition is initially difficult to identify, doctors often monitor at-risk infants for signs of withdrawal for at least a week after birth.

In some cases, symptoms of NAS can appear on the day of birth. A 2009 study published in the Journal of Human Lactation found that a newborn who was born to a mother treated with transdermal fentanyl patches throughout pregnancy experienced symptoms within hours of birth. This occurrence is due to the ability of fentanyl to rapidly cross over the blood-brain barrier.

Newborns experiencing NAS are typically hard to calm. To ease the baby, doctors and nurses often use measures called “tender loving care.” These techniques include swaddling the child in a blanket, gently rocking the baby and reducing the lights and noise in the room.

These babies may receive morphine, methadone or buprenorphine to alleviate withdrawal symptoms. Buprenorphine has become the standard of care in the treatment of NAS. Many infants with NAS stay in the hospital until their symptoms subside, which can take weeks or months depending on the severity of the condition.

Fentanyl can damage the health of the mother and the unborn baby

In a 2005 study, a 31-month-old toddler born with NAS from fentanyl exposure showed only mild withdrawal symptoms and no apparent long-term complications. But Seattle Children’s states that behavioral and developmental problems are common in children who experienced the disorder.

Some specific long-term problems associated with NAS include:

  • Cognitive and motor development problems
  • Infection of the middle ear (Otitis media)
  • Vision complications
  • Increased risk of sudden infant death syndrome
  • Increased risk for future substance use

A 2017 study examined whether NAS affected academic performance among Australian students born with the disorder. The study’s researchers found a strong correlation between NAS and poor or deteriorating school performance later in life.

To combat the risk of academic failure among these students, researchers concluded, “Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.”

If you are dealing with chronic pain during pregnancy, talk to your doctor. They can either prescribe you an appropriate dosage of painkillers or suggest other pain management techniques.

According to the American Society of Anesthesiologists, alternatives to opioids for managing pain include:

  • Over-the-counter medications
    • Non-prescription pain relievers, such as aspirin or acetaminophen, are non-addictive medications that can help alleviate minor aches and pains. However, it is important to consult with your doctor before taking an over-the-counter drug.
  • Acupuncture
    • Acupuncture involves inserting thin needles into the body to relieve pain. According to a 2014 study published in the journal Acupuncture in Medicine, acupuncture is relatively safe during pregnancy.
  • Physical Therapy
    • Physical therapy includes everything from aquatic therapy to yoga. Exercise can reduce pain and improve your ability to function. Deep-muscle massages can also help alleviate pain.
  • Injections or Nerve Blocks
    • Muscle spasms and nerve pain can be distressing, but injections with anesthetics or other medications can provide temporary relief. Before receiving injections, speak with a health care professional about the pros and cons of this method of treatment.

It is important to try, when medically appropriate, to find methods for improving pain that does not include opioids. Fentanyl use is associated with many adverse events, including overdose, and prenatal use of the drug can cause dependence in the newborn and addiction in the mother. If you are addicted to fentanyl, your health, relationships and job performance can quickly deteriorate.

If you are dependent on fentanyl but plan on having children in the future, it is important to seek professional assistance first. Using fentanyl during pregnancy can lead to a host of health issues for you and your baby. However, receiving treatment for a substance use disorder can greatly reduce the risk of pregnancy complications.

The Recovery Village provides evidence-based addiction treatment. At rehab, trained health professionals cater to treatment plans to meet a patient’s specific needs. They can help you gradually taper off fentanyl in a safe and supportive environment.

Mental health counselors can help you identify the underlying cause of your addiction and learn healthy ways to deal with stress. People of all ages and backgrounds who are treated at The Recovery Village have gone on to live healthy, fulfilling lives. Call The Recovery Village at  888.924.4256.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.