Almost 1,000 babies born in Maine last year entered the world already exposed to drugs. For many, if not most, the obstacles to a healthy life didn’t end there. After enduring withdrawal symptoms that leave hundreds of Maine babies hospitalized during their first weeks of life, the infants often return to homes stricken by poverty and parents unprepared to care for them.
While scientists are still researching how the babies fare over the long term, illicit drug use during pregnancy is associated with a variety of harmful effects, ranging from low birth weight to developmental delays, according to the National Institute on Drug Abuse. Even more important to the babies’ future, however, is their home environment, research shows.
“When there is violence in the home, strangers in the home, lack of stable anything, when you take any child and they’re raised in an environment where parents don’t have good supports and they’re not making good choices for themselves, and then you add prenatal exposure to that, they’re going up against two challenges overlayed on top of each other,” said Andrea Pasco, fetal alcohol spectrum disorder and drug-affected babies state coordinator at the Maine Department of Health and Human Services.
Children born drug-affected in Maine are receiving increasing attention from media and politicians as their numbers rise.
Last year, 927 babies were born affected by drugs in Maine, more than 7 percent of all births, Gov. Paul LePage said in his State of the State address last week. That’s a significant increase from 779 babies in 2012, and nearly six times the total of 165 babies in 2005.
Medical providers are careful to note the babies aren’t “drug-addicted.” Addiction involves a pattern of behavior that infants are incapable of, including seeking a high, they say.
“We must hunt down drug dealers and get them off the streets,” LePage said in his address. “We must protect our citizens from drug-related crimes and violence. We must save our babies from lifelong suffering.”
The focus is particularly sharp on children whose mothers used opiates during pregnancy, whether by abusing prescription painkillers or participating in methadone treatment.
Babies born to mothers addicted to narcotics often suffer from neonatal abstinence syndrome, or NAS, a group of withdrawal symptoms that includes tremors, twitching and persistent crying.
Chris Rudd works as a consultant for child care providers and families in Washington County who have children with developmental or behavioral challenges. Most of the children have these challenges because they’ve experienced some sort of trauma.
“NAS babies — certainly we know that’s trauma,” Rudd said.
But once those children get beyond infancy, it becomes increasingly difficult to determine how exposure to opiates in the womb may affect them as they grow.
“It’s so much bigger than that,” she added. “It’s trauma in general. We have children who have been exposed to all sorts of trauma in their young lives — be it domestic abuse, child abuse, poverty.”
Alcohol and smoking most dangerous
Research initiated in the early 1990s has examined the effects of prenatal drug exposure. Now in its 13th year, the Maternal Lifestyle Study is considered one of the largest and most definitive studies into how prenatal drug exposure affects children as they grow.
The study found modest effects on babies’ self-regulation, a crucial development in early childhood that involves children’s ability to control their bodily functions, manage strong emotions and maintain focus and attention. But those effects were far outweighed by the babies’ home environments, according to Dr. Richard Barth, dean of the school of social work at the University of Maryland.
“If you reduce the aversiveness of their child-rearing, the effects of the early drug exposure come down to nearly zero,” he said.
The research has upended fears dating to the 1980s that children exposed to cocaine in the womb would face lifelong consequences, Barth said.
“Alcohol is the most damaging of all the prenatal substances, with smoking probably coming next,” he said.
Babies born to mothers who abuse drugs, especially when alcohol and tobacco are also involved, face a higher risk of prematurity, smaller head circumference and low birth weight, all clear risk factors for social, cognitive and motor delays associated with long-term developmental problems.
The cycle of intoxication and withdrawal typical of illicit drug use also increases the risk of miscarriage and stillbirth, according to Dr. Mark Brown, a pediatrician and neonatologist at Eastern Maine Medical Center in Bangor who treats drug-affected newborns. Nearly half of all babies whose mothers use illicit drugs are born premature, compared with 18 percent with mothers on methadone and 12 percent of babies with mothers on buprenorphine, another replacement drug, he said.
Because of those risks, pregnant mothers addicted to opiates are encouraged to enter a methadone or buprenorphine treatment program, rather than wean off their narcotics, he said.
Brown and researchers at the University of Maine have studied the health of drug-affected babies for nearly a decade. So many of the babies face daunting challenges after leaving the hospital — including poverty, a poor diet and mothers and fathers with limited parenting skills — that isolating the effects of prenatal exposure to opiates proves exceedingly difficult, said Marie Hayes, a UMaine psychology professor and one of the chief researchers.
Many of the infants also were exposed in the womb to tobacco and alcohol, she said.
“You’re looking for a needle in a haystack, when the tsunami is the nutrition, the disadvantage, and the tobacco and alcohol,” Hayes said. “The opiates are just another piece of the cocktail.”
The Maine study compares the babies of mothers in methadone treatment to a control group of infants from similar socioeconomic backgrounds with no prenatal exposure to opiates.
“What we find, more often than not … is the control group and the methadone-exposed infants are more similar than different,” Hayes said.
Doctors warn addicted mothers against quitting narcotic drugs cold turkey, which can endanger the baby and potentially lead to miscarriage. While newborns can experience withdrawal when their mothers take methadone or other replacement drugs such as buprenorphine, the symptoms typically are milder than with street drugs or prescription painkillers.
Babies exposed to drugs in the womb have displayed subtle problems developing their stress response, Hayes said. As those children grow up, that disruption during infancy could manifest as a low tolerance for frustration and new challenges, both crucial to the learning process, she said.
‘The most disadvantaged among us’
The number of students receiving special education services in Maine rose steadily between 1986 and 2004, according to data provided by the Department of Education. The number has hovered around 16 percent for the past five years.
“Certainly, the students needing special education services as a percentage of the total students enrolled has increased,” Education Department spokeswoman Samantha Warren said Monday in an email. “But from the department’s perspective, there are a wide range of reasons for that and while this is likely one of them, others include greater awareness, emerging exceptionalities (autism for example), etc.”
Babies whose mothers are in treatment for opiate addiction, taking the required methadone dose each day and completing counseling, fare better than babies born to mothers who aren’t in treatment, Hayes said.
Some infants in the study group are more irritable, but whether that’s a result of their mothers’ methadone treatment or parenting remains unclear, Hayes said. Women addicted to opiates already are suffering from at least one mental illness, often growing up in homes with child abuse or substandard parenting themselves, she said.
“They don’t know how to interact with their infants, and so the infants are irritable. So the question then is, is it the mom or the baby?” Hayes said.
So far, the UMaine and EMMC researchers have studied the babies until age 3. The hope is to attract funding to continue the research as the babies grow. Little research has been performed into how babies exposed to opiates in the womb fare as they enter school and beyond, Hayes said.
As a provider at Early Childhood and Consultation Outreach, Rudd said the children she works with have regulatory and sensory challenges, meaning they may have trouble keeping themselves calm or react harshly to certain types of light or sound. She said the solutions can be as simple as dimming the lights in a classroom or letting a child punch a pillow if that’s how he or she needs to release energy.
Child care professionals interviewed for this story agreed that though the challenges facing these children can be daunting, with the right interventions, their effects can be reduced.
“A mom in recovery who’s receiving lots of support from MaineCare, local communities, ensuring good nutrition — those children are definitely going to have better outcomes because that environment is an enriching and safe environment,” said Pasco.
Even a healthy baby’s brain development would be affected by living in poverty, with stresses ranging from a parent’s unemployment to domestic violence to even losing heat during cold Maine winters, Hayes said.
“These folks are coming from the most disadvantaged among us,” she said. “The quality of the postnatal environment is going to be similar for the baby as it has been for the mother, it’s generational. Those effects are profound.”