An overview of heroin and its teratogenic effect on infant and fetal development

Heroin - general information

Heroin is a drug processed from the seed pod of certain varieties of poppy plants. It is the most widely abused of all opiates; 3.5 million Americans aged twelve years and older have admitted to trying heroin at least once. Heroin can be injected, smoked, or snorted, and is an extremely addictive drug. Researchers from the National Institute on Drug Abuse have confirmed that every form of heroin administration are addictive ( http://www.whitehousedrugpolicy.gov/drugfact/heroin/index.html ) Once a user is addicted to heroin, their tolerance develops, leading them to need more and more heroin to get the same intense effect they are searching for.

There are many side effects of using heroin, including both short and long term. Also, serious problems are known to be caused from the use of heroin, such as fatal overdose and spontaneous abortion.

Short-term Effects may include:

-initial feeling of euphoria, followed by an alternately wakeful and drowsy state

-dry mouth

-warm flushing of the skin

-heavy extremities

-breathing slowed to the point of respiratory failure

-mental functioning disturbed from depression of the central nervous system

Long-term Effects may include:

-collapsed veins

-infection of the heart lining and valves

-liver disease

-abscesses

-pulmonary complications

A serious side effect of using heroin is withdrawal, which can happen just a few hours after the last use of heroin. Withdrawal symptoms can include drug craving, muscle pain, restlessness, bone pain, and vomiting. These symptoms are most intense 48-72 hours after last dose, and subside after a week.

Prenatal effects of maternal heroin use

Nearly 4 % of all pregnant women are users of illicit drugs during pregnancy. There are several effects that the use of heroin has on the fetus during development, though it is difficult to test and study the exact mechanisms at work and exactly how the drug is affecting the fetus. Animal studies have been conducted on the subject, though it is difficult to extrapolate animal findings to humans as humans differ greatly in physiology (Bashmore). More recently, research has been done on the placentas of rhesus monkeys, as they are more similar to humans physiologically. It has been found that heroin, like morphine (used as a pain killer during birth), is transferred into the placenta very rapidly, and the drug exerts its effects on the fetus. Blood tests at birth have shown the infant's blood levels to be 50% or even 100% of the mother's drug level. With this knowledge, we still are far from understanding exactly how heroin affects a fetus in the womb.

During pregnancy the use of heroin can lead to poor fetal growth, premature delivery, and still birth. Premature rupture of the membranes also occurs, meaning that the bags of waters that hold the fetus break too soon causing premature birth. Diseases and infections related to the mother's drug addiction, like venereal disease such as syphilis and hepatitis can be transmitted to the fetus. Using heroin also raises the baby's risk of contracting the HIV virus if the mother used heroin intravenously. There is a minimum 4-5% chance that the baby will have a major birth defect, although it may not be evident right away.

Since the introduction of methadone programs, a drug used as a replacement for heroin, treatment of heroin addiction while pregnant has been controversial. Some are concerned with higher occurrence of complications and greater severity of withdrawal symptoms upon birth, while others support the treatment. If a mother stops using the drug "cold turkey," the fetus will then experience withdrawal symptoms in the womb, with may cause wide swings in the baby's blood level from intoxication to withdrawal, which often times leads to death and spontaneous abortion, premature birth, and other negative effects. (Bashmore, 508, http://www.nida.nih.gov/Diagnosis-Treatment/diagnosis3.html). The best thing for the mother to do would be to consult a health care provider or drug treatment center about a methadone program, which will be less harmful for the baby. (http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=0&page_id=800&query=heroin&hiword=HEROINES%20heroin%20)

Heroin and its effect on children after birth

It is estimated that about 3,000 babies are born in New York City each year to addicted mothers. It is difficult to determine whether heroin alone is responsible for the harmful effects observed at birth and later in the child's life. Mothers who use heroin are usually from a lower socio-economic status, and typically have other serious problems including malnutrition and possible exposure to other illegal drugs. Venereal disease occurs more commonly in addicted mothers. There is a significantly higher prevalence of syphilis as well as hepatitis resulting from the use of unclean or communal needles. Each of these could also be acting as a teratogen.

Because there are no observable physical abnormalities in infants born from addicted mothers, heroin's classification as a teratogen has been questioned. According to the University of South Florida's Coordinator of the Teratogen Information Service, Suzanne R. Sage, R.N., M.S., M.Ed. "...the magnitude of teratogenic risk associated with heroin is non to minimal," http://www.adoptlink.com/heroin.htm. However, this is NOT to say that babies whose mothers use heroin during the prenatal stage are free of harmful side effects. These effects manifest as behavioral and cognitive developmental deficiencies.

Babies born to mothers who have used heroin while they were pregnant have inherited their addiction, and upon birth must go through withdrawal. This is a painful process and includes symptoms like diarrhea, sweating, a higher-pitched cry, tremors and irritability (Bukatko, 125). The babies are also very likely to have low birth weight and small head circumference.

Babies born with low birth weight have been shown to have many difficulties later in life:

~Language, visuomotor, and other learning disabilities

~Behavior problems

~Children are more likely to be rejected by peers

~Performance in school may suffer and the children may need special education courses

These effects can be counter-acted if the child receives intense hands-on nurturing early in life!

When the mothers cannot take care of their children, they are given to foster agencies where they have a lot of trouble due to their behavioral problems, which often include hyperactivity and short attention span (http://www.sciencemag.org/cgi/reprint/202/4369/733.pdf?ck=nck).

References:

Bashmore, Richard A. Heroin Addiction and Pregnancy. West J Med. 1981, June; 134(6): 506-514.

Bukatko, Danuta. (2008). Child and Adolescent Development: A Chronological Approach Boston : Houghton Mifflin Company.

University of South Florida (1998). Heroin. Retrieved September 26, 2007 from http://www.adoptlink.com/heroin.html

Illicit Drug Use During Pregnancy. Retrieved September 27, 2007 from http://www.marchofdimes.com

Diagnosis and Treatment of Drug Abuse in Family Practice. Retrieved September 27, 2007 from http://www.nida.nih.gov/Diagnosis-Treatment/diagnosis3.html

Teratogens Acting Through Males (1978). Retrieved September 27, 2007 from http://www.sciencemag.org

Heroin Abuse and Addiction. National Institute on Drug Abuse (2000). Retrieved September 29, 2007.

http://www.nida.nih.gov/ResearchReports/Heroin/Heroin.html

Heroin. Drug Facts: Office of National Drug Control Policy. Retrieved September 29, 2007.

http://www.whitehousedrugpolicy.gov/drugfact/heroin/index.html