Pregnancy, Breastfeeding & Substance Use

Alcohol, drugs and pregnancy aren't a good mix. But what is "safe" for your baby? Here's what we know...

Opiates (Oxycodone, Tylenol #3, Heroin, Morphine, Demerol)

Opiates are not linked to any major malformations in the fetus, but there are no definite conclusions.

Withdrawal during the third trimester of pregnancy can lead to premature labour.

If a woman becomes pregnant and considers tapering off her drug use, it needs to occur before the third trimester and must be done slowly.

Withdrawal can have serious consequences for the baby.

Opiate Withdrawal in the Newborn

• Symptoms begin six to 24 hours after the last dose.
• Signs and symptoms of neonatal withdrawal are poor feeding, irritability, sweating, tremors, vomiting and diarrhea.
• Neonatal withdrawal only occurs if the mother uses opiates regularly during pregnancy. It is difficult to diagnose if the mother doesn't disclose use.
• The baby can have seizures and death can occur in untreated cases.
• Withdrawal can start 24 hours or up to two weeks later, and can last several weeks. It is much worse if the mother is using alcohol and benzodiazepines, such as Valium.

Opiates & Breastfeeding

A minority of women have a gene that allows them to convert codeine rapidly into morphine, which makes it available in higher concentrations in the breast milk. This rapid conversion puts the baby at risk.

Know the signs and symptoms that the mother is using drugs:

• "Nodding Off
• Confusion
• Pinpoint Pupils
• Shallow and Slow Breathing

Withdrawal signs and symptoms include:

• Nausea & Vomitting
• Diarrhea
• Sweating
• Muscle Pain
• Chills
• Runny Nose & Eyes
• Agitation & Nervousness (from drug craving) 

Signs and symptoms in the baby include:

• Over-Sleeping
• Grogginess
• Not Waking to Feed
• Poort Latching
• Poor Sucking & Swallowing
• Grey Skin
• Slow Breathing
• Poor Weight Girn
• May be limp and may be worse after four days, possibly due to accumulation of the drug.

Seek emergency medical treatment if signs and symptoms are present.

Methadone

• Does not cause birth defects and is safer than illicit opioid use.
• Dosage requirements may change during pregnancy and need close monitoring. 
• See Methadone Saves Lives

Methadone & Breastfeeding

• Methadone levels are low in breast milk.
• The baby may have withdrawal symptoms, but they can be managed by a family physician.
• Benefits outweigh risk.
• Maximum level in breast milk is reached two to four hours after dose, so timing of breastfeeding helps.

Alcohol

Alcohol & Pregnancy Don't Mix 

Check the list of services in Waterloo Region: Services for pregnant or breastfeeding women involved with alcohol and/or drugs,

Also, check for more information on the Alcohol in Pregnancy page.