In this essay, I plan on investigating the extent that prenatal substance abuse of heroin will have on an addicted fetus. I will be looking at the fetus at four different stages; during pregnancy, after birth, early life and later in life. At each stage, I will outline the vast number of different issues that the fetus/child will commonly have to overcome and how that links to the heroin addiction that the mother had. In the first section,(Issues during pregnancy), I will discuss how heroin travels from the mother to the fetus and the complications that it will cause for both the mother and exposed embryo. In the second section, (Issues after birth), where the child will be going through withdrawal. This can lead to a variety of complications ranging from minor issues like mottled skin to something as severe as death. In the third section entitled Issues during early life) I will be focusing on children between the ages of 2 and 5. I chose this age group as it is the most crucial time in both cognitive and emotional development. Therefore, any signs of brain damage and behavioural issues will be most prevalent here. Throughout this section, I will be focusing on issues like; the child’s behaviour, social interactions and their cognitive development. Although these characteristics may not be issues at this early stage of life, if not corrected, they could escalate and get considerably worse. In the final section, I will
talk about the symptoms that continue into later life. These include; lower IQ levels, reoffending rates, life expectancy and higher incidence of ADHD.
Although heroin can cause a large number of drastic effects to the mother, the ones that pass on to the child tend not to be so extreme in comparison to other drugs like cocaine. The common issues that may arise aren't too serious or permanent, with very few being fatal. However, the severity of the symptoms will be relative to how serious the mother's drug abuse is.
Prenatal substance abuse occurs when a fetus is exposed to drugs, in this case, heroin, throughout pregnancy. The drug is passed through the umbilical cord into the placenta where it then enters the fetus’ bloodstream. The heroin in the blood travels around the body to the central nervous system, where it binds to specific receptors, which stimulates an increase in the release of dopamine into the brain. Heroin, also known as diamorphine, is a highly addictive opioid drug. Heroin can also slow the motor functions which is why people often feel relaxed and dazed.
Heroin enters the brain by the blood-brain barrier, ‘this is a barrier between the brain’s blood vessels (capillaries) and the cells and other components that make up brain tissue’. The blood-brain barrier prevents pathogens that could cause harm, from entering the brain. The blood-brain barrier also allows fat-soluble molecules to diffuse through and enter the cerebrospinal fluid that is located in the brain. When in the brain, the opioids bind to receptors and cause the release of dopamine.
Issues during pregnancy:
Heroin massively impacts on the mother’s life, during pregnancy with the mother experiencing a variety of different side effects from the drug. Some of these side effects include; antepartum haemorrhaging, preeclampsia and respiratory failure.
An antepartum haemorrhage is the bleeding from the birth canal after the 24th week of pregnancy This can lead to an increase in the risk of both maternal and infant mortality rates. Preeclampsia occurs when the placenta does not function properly causing the blood pressure of the mother to get too high. This is paired with a high protein level in the urine, this high level indicates that the mother has proteinuria which is a clear sign that the liver isn’t functioning properly. The high blood pressure can cause swelling in the lower body and it often develops in the 20th week of pregnancy and can cause severe complications like fetal growth restriction. ‘Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients.
Mother's can also suffer from respiratory failure, due to the fact that heroin can slow down the function of the lungs, and cause them to fill up with liquid which can lead to a variety of other complications. As well as this, contaminants in heroin can clog the capillaries surrounding the alveoli, restricting the amount of oxygen that can be absorbed. The reduction in oxygen levels going from the mother to the child can result in numerous complications as the fetus will become underdeveloped.
As well as this, the mother can face a variety of issues that will affect her personal health. These include an increased risk of HIV and Hepatitis C, which can easily be acquired by sharing needles with an infected person. HIV is a virus that infects the body and causes AIDS. AIDS is an Acquired Immune Deficiency Syndrome, meaning that the infected immune system is too weak to fight off infection. If the mother is infected with HIV this can be passed across the placenta into the fetus, or during breastfeeding as it can be transmitted in the mother’s breast milk. Hepatitis C is the inflammation of the liver, often the result of a viral infection. Hepatitis C is spread through blood-blood contact with an infected individual and is ‘most commonly spread through sharing needles used to inject drugs’. Hepatitis can also be passed from mother to baby, however, this is very rare. ‘About 6 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C’.
During pregnancy, a mother can experience problems with the placenta such as placental abruption which is when the ‘placenta partially or completely separates from your uterus before your baby's born’. It often occurs after an antepartum haemorrhage and preeclampsia. The placental abruption can cause a reduction in the amount of oxygen and nutrients that the fetus will receive, meaning that it becomes more susceptible to a variety of different conditions like cerebral palsy. ‘Cerebral palsy is the name for a group of lifelong conditions that affect movement and coordination, caused by a problem with the brain that occurs before, during or soon after birth’. Cerebral palsy is caused by a trauma to the developing brain, in this case, the lack of oxygen, limiting its growth and becoming underdeveloped.
Another issue that can happen during pregnancy is the premature rupture of membranes (PPROM), which can lead to premature birth, stillbirth and miscarriages. The premature rupture of membranes, also known as waters breaking early, can increase the chances of infection, which can lead to an increase in the chance of both maternal and fetal death. If the rupture happens before the 23rd week of pregnancy the chances that the baby will survive are very small. However, if it occurs after 30 weeks there is a greater than 95% chance that the baby will survive. This is due to the fact that after 24 weeks the baby’s lungs and other vital organs become developed enough in order to survive.
An additional symptom that is often associated with the prenatal substance abuse of heroin is low birth weight. ‘Low birthweight is a term used to describe babies who are born weighing less than 5 pounds, 8 ounces’. A low birthweight has a variety of different causes, with the most common being premature birth. Premature birth is when a baby is born before 37 weeks. Low birthweight can lead to a variety of different health problems for example, breathing problems such as infant respiratory distress syndrome and neurologic problems, such as intraventricular hemorrhage . Infant respiratory distress syndrome is when the baby’s lungs aren’t fully developed and therefore are not completely functioning, which lead to breathing issues. Due to the lower levels of oxygen that the baby will be getting it can lead to a variety of different developmental issues in later life such as ‘learning difficulties, movement problems, impaired hearing and impaired vision’. Intraventricular haemorrhage is excessive bleeding into the brains ventricular system. The brains ventricular system is ‘the spaces in the brain containing the cerebrospinal fluid’. Intraventricular hemorrhage can cause a large amount of brain damage, some of which can be permanent, however, most infants are able to fully recover. In the worst cases, it can lead to permanent ‘cognitive and emotional disabilities’.
One of the more dramatic issues that can happen during pregnancy in which heroin is taken by the mother is premature death and miscarriage. Miscarriage ‘is the loss of a pregnancy during the first 23 weeks’. In a pregnancy where the mother has been using heroin, the most likely causes of the miscarriage would be HIV, sudden heroin withdrawal, STIs and kidney damage. HIV causes an inflammation of the amniotic sac and placenta. This inflammation can be caused from a bacterial infection in the cervix or vagina that moves to the uterus, affecting the fetus. This inflammation of the feto-maternal interface (placenta) will cause a miscarriage if it falls outside of the optimal range. Sudden heroin withdrawal is when the mother stops taking all form of heroin abruptly and causes the body to start to shut down in order to expel the foreign cells (heroin) from the body.
To conclude, whilst the effects that heroin has on the fetus during pregnancy can be great, the majority of the symptoms that are seen have a larger and more drastic effect on the mother. The effects on the baby are often only temporary, however, due to the brain damage that can be caused it may lead to a large number of serious issues in later life.
Issues after baby's birth:
As one has seen after a child who was prenatally exposed to heroin is born, there is a large possibility that the child will become dependant on the drug. This means the baby will need to undergo a wide variety of treatments in order to attempt to safely wean the child off heroin. However, as the first few months of the baby’s life is crucial to both neurological and physical growth, a large number of conditions and issues can arise if the withdrawal treatment goes wrong.
During the withdrawal phase, the babies brain will experience a shock as it no longer has access to the heroin. This can cause a large amount of brain damage as the sudden shock will cause both breathing and heart rate to slow, this reduces the amount of oxygen getting to the brain. The reduction in oxygen leads to cerebral hypoxia, which can cause brain cells to start to die off, as quickly as 5 minutes.
One of the most drastic consequences of heroin abuse during pregnancy is SIDS. SIDS stands for Sudden Infant Death Syndrome. This is when a child of less than one year of age suddenly dies with no explanation. Infants born with a low birthweight or prematurely are most at risk (both of which are consequences of prenatal substance abuse of heroin). Babies who die of SIDS are thought to have issues with their hearts and respiratory systems, both of which relate to the mother using heroin whilst the fetus is in utero.
Another effect of the prenatal substance abuse of heroin is NAS, Neonatal Abstinence Syndrome. ‘NAS is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics’. Opiate drugs like heroin are the most common drugs to cause NAS as they have a higher proportion of babies becoming dependent and therefore, causing them to then have to withdraw. NAS is caused when the fetus develops a dependence and addiction towards the drug. After birth, the baby continues to be dependent and addicted to the drug and as the heroin is no longer available to them their central nervous system, meaning that it ‘becomes overstimulated causing the symptoms of withdrawal’. There are a large number of symptoms of NAS which include; crying, mottled skin, fever, irritability, slow weight gain, poor breastfeeding, tremors, diarrhoea, vomiting, hyperactivity and in extreme situations seizures and death.
Mottled skin is when the skin appears patchy and occurs due to an underdeveloped circulatory system. Due to the common occurrence of preterm birth the circulatory system is often underdeveloped, which causes a build up of blood in the capillaries close to the surface of the skin, giving it the patchy appearance.
A fever is when the body temperature exceeds the normal range of 36-37° celcius. ‘A high body temperature, or fever, is one of the ways our immune system attempts to combat an infection’. The fever could be the result of a hypersensitive reaction, as the baby’s immune system is weak so will attack any foreign cells.
The most common symptom that prenatally exposed babies express is irritability, this is ‘the excessive sensitivity of a bodily organ or part to a stimulus; undue susceptibility to the influence of a stimulus. However, there is no evidence supporting a direct correlation between babies expressing irritability and the exposure to heroin in utero.
Slow weight gain is when a baby is gaining weight at a slower pace than other children who are the same age and sex. This is linked to poor breastfeeding (which is another symptom of NAS) as the volume of food and number of calories that the baby is consuming is reduced. The baby could struggle to breastfeed as heroin reduces motivation which would cause the baby to refuse to feed and suckle. Heroin also has suppressive effects as the consumption of the opiate can cause the suppression of the pituitary gland, which can cause the reduction in the volume of hormones and chemicals that regulate appetite produced.
Tremors are ‘unintentional, rhythmic muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body’. They occur when there are problems in the section of the brain that control the muscles. In the case of heroin it releases a large amount of dopamine into the brain, which causes the inhibitory gamma-aminobutyric acid interneurons to be blocked. Gamma-aminobutyric acid is ‘an amino acid which acts to inhibit the transmission of nerve impulses in the central nervous system’. When the gamma-aminobutyric acid interneurons are blocked the mesocorticolimbic dopaminergic neurons are activated. Mesocorticolimbic dopaminergic neurons transfer dopamine from the ventral tegmental area which causes a full-blown neurotoxic reaction which can damage the brain and therefore lead to tremors, and in severe cases seizures.
When the baby is withdrawing from heroin it is very common for them to experience both vomiting and diarrhea. This is due to the fact that heroin alters the body’s normal functions. The chemical structure of the heroin allows it to bind to the opioid receptor in the brain. This can alter the way that the body responds to both pain and pleasure, which will force the body to attempt to remove the foreign substance usually in the form of vomiting and diarrhoea.
To conclude, the issues that occur after birth, during the withdrawal phase can be the most detrimental to the health of the baby’s brain. The child is susceptible to a large amount of brain damage due to the sudden shock that the brain undergoes after it no longer has access to the heroin. The brain damage will be more obvious as the child starts to develop intellectually and start to learn to read and write.
Issues in Early life ( Aged 2-5)
The first few years of a child’s life are the most crucial for physical, intellectual, and social-emotional development. Therefore, after experiencing a withdrawal during the beginning of this period, it can lead to an onset of predominantly cognitive and mental issues, as brain damage may have occurred. These will become considerably more prevalent as the baby gets older and becomes more educationally advanced. However, many studies do not include the disparity between social classes, family values, parental presence and access to education, making them slightly inaccurate and not fully representative.
The most common and obvious issue that displays itself is in the form of behavioural issues or disruptive behaviour disorder. These issues are often thought to be linked with the stability of their home life. A child born with a prenatal addiction to heroin is likely to have a very unstable home life. This is proven in a study written by which a drug rehab center which states that ‘only a small percentage of babies born to heroin-addicted mothers still live with their biological mothers at the five year mark’. This absence of a role model can lead children to act out and lack authority. Behavioural issues and disruptive behaviour disorders are terms used to describe ‘uncooperative, defiant, and hostile behaviors toward authority figures that seriously impacts a child’s daily functioning’.
One of the issues that will become more serious with age is difficulties with communication and like behavioural issues, this can escalate with an absence of a role model like a mother. A communication disorder is ‘any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others’. Difficulties with communication can be a early sign of autism and studies have shown a link between addiction and autism. The studies mainly state that people with autism are more likely to abuse drugs in later life, due to the fact that they ‘are more likely to struggle with social interactions. These people may also consume alcohol in order to 'cover up' feelings of social ineptness.’ Autism is ‘a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them’. As autism is a genetic disorder, the mother might not only give birth to a child that is dependant on heroin, but one that also has autism. The autism in children with prenatal addictions can commonly go undetected, as their symptoms are viewed as a side effect of the withdrawal.
Hyperactivity, also known as ADHD, is associated with children who had prenatal opioid addictions. It is as high as 15 times more common for a child exposed to drugs in utero to have mental health issues like ADHD than a child who underwent a normal pregnancy. Studies show that illicit drugs can influence neurodevelopment in children, however it is debated as to what extent the ADHD is caused by the chemicals in the drug or the child’s surroundings (like lack of role model or being placed in the care system). ADHD is ‘a chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsivity. ADHD begins in childhood and often lasts into adulthood. As many as 2 out of every 3 children with ADHD continue to have symptoms as adults’. ADHD can massively complicate the child's life causing them to face an array of both physical and mental health issues. The majority of these issues will only become problematic in later life, however, issues with education and social interactions can cause anxiety when the child first starts to attend school aged 4-5.
The symptom that can cause the biggest issues throughout life is the aggressive behavior that children can display, and this is another issue that will worsen throughout life. Aggressive behaviour ‘can cause physical or emotional harm to others. It may range from verbal abuse to physical abuse. It can also involve harming personal property’. Aggressive behaviour in children can worsen due to lack of discipline, which as many of the parents are not present, is often not implemented. This means that many of the children did not have an authority figure to teach them the difference between right and wrong. The extent to which aggressive behaviour is a direct symptom of a prenatal opioid addiction is a highly debated subject, as many believe that it is just a social issue.
A complication that can be a large issue at such a young age is a lack of social inhibition. This is mainly due to the fact that between the ages of 2 and 5 the child should be starting school (or nursery) and therefore interacting with other children. A lack of social inhibition is ‘ a conscious or subconscious avoidance of a situation or social interaction’. A lack of social inhibition can cause the child to further distance and isolate themselves from the rest of society. At such a young age it can cause an onset of anxiety and avoidance of social situations. It is thought that the caregivers can affect social inhibition of a child, therefore if the parents aren't present it could worsen the child’s condition.
During the phase of early life, the child can also experience Early life stress (ELS), this is the build up of stress within the first few years of the child’s life. This can cause the oxytocin receptors to be blocked, which can lead to a large amount of long term issues. Oxytocin is a hormone that is produced by the hypothalamus, it is known as the ‘love hormone’ as it plays a crucial role in sexual reproduction, it is also used for the bonding that occurs between a mother and her child. This means that as it is no longer being produced the relationship that a mother and her addicted fetus has is often not very positive, I can infer that this is a large factor which leads to a large number of prenatally addicted children being put into the care system. However, it also prevents addictions from occurring, this is due to the fact that oxytocin enables the production of hormones like dopamine, which are the same hormones that are released when heroin is consumed. Therefore, if it is not being produced then the dopamine isn’t being produced, which can cause people to attempt to recreate the ‘happy’ feeling with drugs.
To conclude, the first few years of a child’s life are the most crucial for physical, intellectual, and social-emotional development. Therefore the symptoms that present itself in this time frame tend to be the most severe and detrimental to later life. They tend to be triggered by brain damage that occurred during withdrawal, and just have not been identified until the child starts to develop cognitively.
Issues in Later life
Any symptoms that have continued into later life will be caused by a more severe case of prenatal opioid addiction. The majority of these symptoms are now permanent and can easily affect the rest of the child's life. The issues that will be most prevalent include; lower IQ levels, high rates of people taking heroin (or any other drugs), lower life expectancy and higher crime rates. However, a lot of the issues that started during childhood, like autism and ADHD, if relevant, will have continued and most likely worsened. All of these issues can cause a large strain on a country's economy, as they will have to pay for the healthcare, education and likely benefits for the affected.
The issues that might have been observed earlier in life, like ADHD and autism, will have a much larger effect on their daily lives. In adults, ADHD can lead to a large number of issues including; unstable relationships, poor work or school performance and low self-esteem. These issues can increase the likelihood of the adult developing depression and in extreme cases, taking their own lives. Due to the issue of poor work or school performance, adults with ADHD can struggle to find work which can cause them to struggle financially. As I mentioned earlier in this essay, adults with ADHD are more likely to become addicted to drugs in an attempt to suppress their feelings. Like ADHD, autism can cause numerous issues in life, predominantly due to the fact that it is difficult for them to get jobs, find friends, and develop relationships. As well as that, people with severe autism need constant care, this reduces the amount of privacy and independence that they have, which can impact not only their mental health but social interactions as well. The likelihood of people with severe autism getting a full-time time job is very small, with just 16% of those with autism have full-time jobs. This is as people with autism can struggle with; multi-tasking, time management and anxiety, all of which are usually crucial criteria for jobs.
Issues like lower IQs and struggling in education can reduce the number of qualifications that an individual gets. This can massively limit their job prospects in the future, especially as many jobs have a minimum requirement of a GCSE in both Maths and English. People who were exposed to heroin in utero are susceptible to having lower IQs due to the fact that the exposure to the drugs may have caused brain damages, as well as the fact that, their upbringings may have lacked academic stimuli. A study was carried out that showed a direct link between people who had been affected when exposed to heroin in utero and a rise in cognitive impairments . The study stated that ‘The exposed group had significantly lower IQ scores than the control group’. It is thought that the environment that the child grows up in has a large impact of their academic ability. It is thought that children with prenatal opioid addictions, who are raised by their biological parents had ‘impaired verbal, performance, and reading and arithmetic skills. Whereas, children born to mothers with heroin dependency but who were adopted at a young age had normal intellectual and learning abilities, but some had reduced function on performance IQ’.
Many sources have suggested that a prenatal exposure to an opioid drug increases the likelihood of the fetus retaking the substance later on in their life. This is due to the fact that they are more susceptible to forming an addiction, as they are not only exposed to the drug throughout their lives, but also as they do not produce normal levels of oxytocin, causing them to recreate the ‘happy’ feeling that is caused by the release of dopamine.
The life expectancy of a person who was exposed to heroin in utero is lower than that of a an individual who had a ‘normal’ pregnancy. This is due to a combination of reasons ranging from social issues to the brain damage that they experienced during the withdrawal phase. The social issues can lower the life expectancy as the individual is more exposed to illicit drugs, possibly causing them to abuse these substances leading to an overdose. The brain damage that they experienced during the withdrawal phase can lower the life expectancy as it can cause a large number of conditions such as autism, which itself doesn’t lower the life expectancy. ‘However, research has shown that the mortality risk among individuals with autism is twice as high as the general population, in large part due to drowning and other accidents’.
The consequences are not limited to the individual, they can extend into the surrounding communities, impacting most heavily on the economy of the country. The economy is affected mainly by the strain that prenatal addictions have on the health system, this is due to the fact that the cost of the medication for both the mother and child is extremely expensive. With Methadone, the most common drug used to wean people off heroin, costing the healthcare system $15.48 per patient, per day.
To conclude, the issues that are experienced in the later stages of the affected individuals life can often be the most serious. This is due to the fact that these are all long term and permanent side effects. They impact the individual in many ways including; lower levels of education, higher levels of autism and ADHD, retaking harmful substances and a lower life expectancy. However, the also impact the wider community by the impact that the addicted and affected individuals have on not only the healthcare system but also the economy.
:Conclusion:
To conclude, the effects that heroin has on the fetus during pregnancy are very great. However, the majority of the symptoms occur have a larger and more drastic effect on the mother. The issues that occur after birth, during the withdrawal phase can be the most detrimental to the health of the baby’s brain. The child is susceptible to a large amount of brain damage due to the sudden shock that the brain undergoes after it no longer has access to the heroin. This is not the case if the mother continues to breastfeed the child, as the heroin is able to travel into the baby’s bloodstream through in the milk. The brain damage will be more obvious as the child starts to develop intellectually and start to learn to read and write, as it will be behind other students of a similar age. The first few years of a child’s life (from age 2-5) are the most crucial for development. Therefore the symptoms that present itself in this time frame tend to be the most severe and detrimental to the child in later later life. Many of the issues are also due to brain damage that occured after the birth of the baby, during withdrawal. The issues that are experienced in the later stages of the affected individuals life can often be the most serious. This is due to the fact that these are all long term and permanent side effects. However, the also impact the wider community by the impact that the addicted and affected individuals have on not only the healthcare system but also the economy.
To conclude, the prenatal substance abuse of heroin affects brain functions of an addicted fetus to a great extent. It not only affects the fetus in utero but also the child throughout its life, with different side effects occurring at different stages. The severity of the consequences is closely related to how much the mother abused heroin. All of the consequences that the addiction leads to will usually only continue into later life if the mother has taken an exceeding amount of the drug.
There is also a huge social aspect that can affect the symptoms that a person can face. If the child remains with its biological parents, they can be exposed to the drug throughout their childhood and may lack parental guidance. This can lead to a lack of discipline and academic stimuli, all of which lead to a higher chance of the individual having ADHD and educational studies.
A large volume of the information that can be found on the topic of Prenatal addictions is not very reliable. This is due to the fact that a considerable number of the mothers who took heroin will have also taken a cocktail of other drugs which they may not have disclosed. This means that it is difficult to distinguish between the side effects that are purely brought on by the Heroin. As there is also a huge amount of proof that suggests that the social environment in which the child grows up in has a large impact. However, it is almost impossible to control the child’s home environment which will also alter the reliability of the results. Some studies suggest that the number of long term outcomes that can be seen in children who were prenatally exposed to heroin decrease if the children do not live with their biological parents, and live with non-addicted parents. This is due to the fact that they improve the environment that the children grow up in, ensuring that they aren't exposed to the drug and have an academic stimulus.