Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) refers to cases in which newborns experience drug withdrawal shortly after birth due to drug exposure in utero.  Today, one of the most common causes of NAS is maternal use or abuse of opioids during pregnancy. In the case of opioids, NAS can result from the use of prescription drugs as legitimately prescribed, from the abuse of prescription drugs, or from the use of illegal opioids like heroin.

The incidence of NAS is on the rise

Between 2000 and 2009, the number of mothers found to be using opioids during pregnancy increased from 1.19 to 5.63 per 1,000 US hospital births.* In that same time period, NAS diagnoses increased from 1.20 to 3.39 per 1,000 hospital births per year.* NAS babies were more likely than all other hospital births to be born at low birthweight and to have respiratory complications, feeding difficulties, and seizures.** The average length of hospital stay for an infant with NAS is 16 days, compared to 3 days for infants born without NAS. Newborns with NAS are more likely to come from low-income communities, and are more likely to be covered by Medicaid.**

NAS is a treatable condition, but long term health effects are unknown 

Infants experiencing NAS often show signs of distress, including long periods of crying, inability to be soothed, tremors, poor feeding, fever, vomiting, seizures, and other symptoms. Newborns with NAS must be properly assessed to customize the treatment appropriately to the infant’s specific needs. Withdrawal from short-acting opiates is usually apparent within the first 24-72 hours of life. However, symptoms may appear as soon as within a few minutes to as much as two weeks after birth. As most symptoms are manifested within 72 hours, many assessment tools use this benchmark for diagnosis of NAS.** 

Pregnant women who are addicted to opioids often do not seek prenatal care until late in pregnancy because they are worried that they will be stigmatized or that their newborn will be taken away.  The March of Dimes supports policy interventions that enable women to access services in order to promote a healthy pregnancy and build a healthy family. Learn more about the condition, including complications it may cause in infants.

The March of Dimes supports policy initiatives aimed at providing care for mother and baby.

  • Access to comprehensive services: Pregnant women who abuse drugs, such as opioids, should have access to comprehensive services, including prenatal care, drug treatment, and social support services. These women often have other psychosocial risk factors that need to be addressed in order to ensure they successfully stop abusing drugs.
  • Priority access and flexible treatment: Drug treatment programs should be tailored to pregnant or parenting women, taking into account the woman’s family obligations, and should provide priority access to pregnant women.
  • Immunity during prenatal visits: Research has shown that obtaining prenatal care, staying connected to the health care system, and being able to speak openly with health care providers about drug use creates a healthy environment for mothers at risk of drug abuse to seek treatment that can improve birth outcomes.
  • Provider Education: Provider education and public awareness efforts can increase the patient-provider discussion on the risks and benefits of various medications, including opioids, and potential risks to the unborn child. Additionally, providers should be educated on the most updated substance abuse screening tools and the standard of care for all obstetrics patients.

The March of Dimes opposes policies and programs that impose punitive measures on pregnant women who use or abuse drugs.

In some states, policymakers have proposed punitive measures for women whose infants experience NAS. The March of Dimes believes that targeting women who used or abused drugs during pregnancy for criminal prosecution or forced treatment is inappropriate and will drive women away from treatment vital both for them and the child.

*Patrick SW et al. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307(18): 1934-1940.
**Hudak ML et al. Neonatal drug withdrawal. Pediatrics. 2012; 129(2):e540-e560.


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