USE OF HEROIN IN PREGNANCY

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(Date of issue: July 2010, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on heroin use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

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.

This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to be sure you are using the most up-to-date version.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.