USE OF HEROIN IN PREGNANCY

Heroin (Diamorphine hydrochloride) is a synthetic opiate used legitimately as an analgesic for severe pain and illicitly as a drug of abuse.  Heroin is mainly abused intravenously but it can also be snorted, smoked or ingested.

Reports of heroin use during human pregnancy are confounded by poor nutritional and health status, exposure to other drugs of abuse, alcohol, cigarettes and other lifestyles that may negatively influence pregnancy outcome.  Despite these added risk factors, most of the data concerning heroin use in human pregnancy provides no convincing evidence for an increased risk of structural malformations.  There is evidence to suggest that in utero exposure to heroin may be associated with impaired neurodevelopment in the offspring, however this research also suffers from similar confounders as those mentioned above.

Intrauterine growth retardation (IUGR) and low birth weight are frequently observed in infants of heroin users and studies have also suggested an increased risk of sudden infant death syndrome (SIDS).

Acute heroin withdrawal has been associated with spontaneous abortion, preterm labour and perinatal mortality.  Substitution with methadone maintenance treatment appears to improve neonatal outcomes although the period of neonatal withdrawal symptoms may be prolonged.  If methadone substitution is used, the lowest effective dose should be given, especially near term, to minimise neonatal withdrawal.

Use of heroin near term may cause neonatal respiratory depression and long-term use may be associated with neonatal abstinence syndrome.  Following maternal use of heroin during pregnancy it is advisable that the baby is observed for at least 72 hours after delivery.

The use of heroin should be avoided during pregnancy, however inadvertent exposure would not be grounds for termination of pregnancy or any additional diagnostic procedures.