Neonatal narcotic withdrawal, called the neonatal abstinence syndrome, may manifest in 40 to 90 percent of exposed newborns (Blinick, 1973; Creanga, 2012; Dashe, 2002; Zelson, 1973). As discussed in Chapter 33 (p. 625), CNS irritability may progress to seizures if untreated and may be accompanied by tachypnea, apneic episodes, poor feeding, and failure to thrive. At-risk neonates are closely monitored using a scoring system, and those severely afected are treated with opioids (Finnegan, 1975). he proportion of exposed newborns developing neonatal abstinence syndrome has risen significantly in recent years (Creanga, 2012; Lind, 2015).
he American College of Obstetricians and Gynecologists (2017 c) recommends that pregnant women with opioid-use disorder be maintained on opioid-agonist therapy to reduce the risks associated with illicit opioid abuse and associated behaviors. Treatment includes either methadone, usually through a licensed outpatient opioid treatment program, or buprenorphine, which may be given in an oice-based setting by a licensed buprenorphine prescriber. A multidisciplinary treatment program is recommended to reduce the likelihood of additional opioid abuse while on maintenance therapy. he College (2017 c) discourages withdrawal from methadone during pregnancy because of high relapse rates. At Parkland Hospital, pregnant opioid users who decline maintenance therapy are ofered inpatient hospitalization for controlled methadone taper, with the goal of reducing the likelihood of neonatal abstinence syndrome (Dashe, 2002; Stewart, 2013).
This is the illicit drug most commonly used in pregnancy (American College of Obstetricians and Gynecologists, 2017a). Based on data from the National Survey on Drug Use and Health, the prevalence of marijuana use in pregnancy was nearly 4 percent in 2014 (Brown, 2017). Cannabinoids are not considered to be major teratogens, but there is concern because endogenous cannabinoids play key roles in human brain development. In one metaanalysis of nearly 8000 exposed pregnancies, adverse outcomes such as preterm birth and low birthweight were increased only in the presence of concomitant tobacco use (Conner, 2016).
Phencyclidine (PCP) or angel dust is not associated with congenital anomalies. More than half of exposed newborns, however, experience withdrawal symptoms characterized by tremors, jitteriness, and irritability. Toluene is a common solvent used in paints and glue. Occupational exposure is reported to have signiicant fetal risks (Wilkins-Haug, 1997). When abused by women in early pregnancy, it is associated with toluene embyopathy, which is phenotypically similar to fetal alcohol syndrome. Abnormalities include pre-and postnatal growth deficiency, microcephaly, midface hypoplasia, short palpebral fissures, and wide nasal bridge (Pearson, 1994) . Up to 40 percent of exposed children have developmental delays (Arnold, 1994).