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Infant of a substance-using mother

IUDE; Intrauterine drug exposure; Maternal drug abuse; Maternal substance use; Maternal drug use; Narcotic exposure - infant; Substance use disorder - infant

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Maternal substance use may consist of any combination of drug, chemical, alcohol, and tobacco use during the pregnancy.

While in the womb, a fetus grows and develops due to nourishment from the mother via the placenta. However, along with nutrients, any toxins in the mother's system may be delivered to the fetus. These toxins may cause damage to the developing fetal organs. A baby also may become dependent on substances used by the mother.

WHAT ARE THE SIGNS AND SYMPTOMS SEEN IN AN INFANT OF A SUBSTANCE-USING MOTHER?

Babies born to substance-using mothers may have short- or long-term effects.

• Short-term withdrawal symptoms may consist only of mild fussiness.
• More severe symptoms may include irritable or jittery behavior, feeding problems, and diarrhea. Symptoms vary depending on which substances were used.
• The diagnosis for babies with signs of withdrawal may be confirmed with drug tests of the baby's urine or stool. The mother's urine will also be tested. However, if urine or stool is not collected soon enough, the results may be negative. A sample of the umbilical cord may be tested.

More significant long-term developmental problems may be seen in babies who are born with growth failure or various organ problems.

• Infants born to mothers who drink alcohol, even in modest amounts, are at risk for fetal alcohol syndrome (FAS). This condition consists of growth problems, unusual facial features, and intellectual disability. It may not be detected at the time of birth.
• Other drugs may cause birth defects involving the heart, brain, bowel, or kidneys.
• Babies who have been exposed to drugs, alcohol, or tobacco are at higher risk for SIDS (sudden infant death syndrome).

WHAT IS THE TREATMENT FOR AN INFANT OF A SUBSTANCE-USING MOTHER?

The baby's treatment will depend on the drugs the mother used. Treatment may involve:

• Limiting noise and bright lights
• Maximizing "TLC" (tender loving care) including skin-to-skin care and breastfeeding with mothers who are in treatment/no longer using illicit substances (including marijuana)
• Using medicines (in some cases)

In the case of babies whose mothers used narcotics, the baby is most often given small doses of a narcotic at first. The amount is slowly adjusted as the baby is weaned off of the substance over days to weeks. Sedatives are sometimes used as well.

Infants with organ damage, birth defects or developmental issues may need medical or surgical therapy and long-term therapies.

These infants are more likely to grow up in homes that do not promote healthy emotional, social, and mental development. They and their families will benefit from long-term support.

References

Hudak M. Infants of substance-using mothers. In: Martin RM, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Abstinence syndromes. In Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 126.

Martin GI. Marijuana: the effects on pregnancy, the fetus, and the newborn. J Perinatol. 2020;40(10):1470-1476. PMID: 32507859 pubmed.ncbi.nlm.nih.gov/32507859/.

Wallen LD, Gleason CA. Prenatal drug exposure. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 13.

Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol. 2014;41(4):877-94. PMID: 25459779 pubmed.ncbi.nlm.nih.gov/25459779/.

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Review Date: 11/9/2021  

Reviewed By: Kimberly G. Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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