In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to heroin might increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What is heroin?

Heroin is a highly addictive opioid. It is smoked, snorted or injected. Street names for heroin include smack, dope, mud, horse, skag, junk, H, black tar, and skunk among others. In the United States, it is an illegal substance and is not available by prescription. This fact sheet discusses heroin alone, but women who use heroin may also use alcohol, tobacco, and other drugs that can be harmful.

I just found out I am pregnant. Should I stop using heroin?

Treatment is available to help you stop heroin. Talk to your health care provider as soon as possible so that you can start treatment. Stopping heroin suddenly (also called “cold turkey”) without proper treatment could cause you to go through withdrawal. Withdrawal symptoms could be harmful to you and may increase the chance of a miscarriage or stillbirth. If you do not have a health care provider, call the national number for drug treatment referral at 800-662-4357. When you call for help, let them know that you are pregnant so that you can get routed to the best facility to meet your needs.

I use heroin. Can it make it harder for me to get pregnant?

Heroin has not been studied in women to see if using heroin could make it harder to get pregnant.

Does using heroin during my pregnancy increase the chance of miscarriage?

There are no published studies looking at whether heroin increases the chance of miscarriage. This does not mean there is an increased chance or that there is no increased chance. It only means that this question has not been answered.

Can using heroin in pregnancy cause birth defects?

Overall, the studies of heroin do not support an increased risk of birth defects. However, heroin often has other drugs, medications and even chemicals added to it. This makes it difficult to know the actual risks for each woman who uses heroin.

Could heroin cause other pregnancy complications?

Studies involving women who use heroin found an increased chance for poor growth of the baby, stillbirth, premature delivery, and c-section. Use of a heroin close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal abstinence syndrome).

Will my baby have withdrawal (neonatal abstinence syndrome) if I continue to take heroin?

Most likely, yes. Studies have reported a risk for neonatal abstinence syndrome (NAS) with heroin use during the third trimester of pregnancy.

NAS is the term used to describe withdrawal symptoms in newborns from medicines that a mother takes during pregnancy. Most often, symptoms of NAS appear two days after birth and may last more than 2 weeks. The most common symptoms of NAS include irritability, poor feeding, tremors, and rigid or loose muscle tone. Most babies can be treated successfully for NAS while in the hospital. If you use heroin or other opioid drugs during pregnancy, it is important that your baby’s doctors know to check for symptoms of NAS so your newborn can get the best possible care.

What do we know about abuse of heroin?

Studies find that pregnant women who abuse opioids have an increased risk for pregnancy problems. These include poor growth of the baby, stillbirth, premature delivery, low birth weight and c-section. Some women who abuse opioids also have unhealthy and risky lifestyles that can result in health problems for both the mother and the baby. For example, poor diet choices can lead to mothers not having enough nutrients to support a healthy pregnancy and could increase the chance of miscarriage and premature birth. Sharing needles to inject opioids increases the risk of getting diseases like hepatitis and HIV, which can cross the placenta and infect the baby.

Will using heroin during pregnancy affect my baby’s behavior or cause learning problems?

This is unknown. The results from studies about behavioral or learning problems in children whose mother’s used heroin during pregnancy are unclear.

Can I take heroin while I am breastfeeding?

No. While there are very few studies on heroin and breastfeeding, heroin easily passes into the breastmilk. Babies that are exposed to heroin could have difficulty breathing, apnea (stop breathing), and cyanosis (not enough oxygen in the blood causing the baby’s skin to turn bluish). The baby’s health care provider should be contacted right away if your baby has any problems. Be sure to talk to your health care provider about all your breastfeeding questions.

What if the baby’s father takes heroin?

Heroin use in men may affect the sperm, making it difficult to become pregnant. Also, if the father has an infection such as hepatitis C or HIV, it can be passed on from the semen to the mother and then to the baby. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

Selected References:

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  • Broussard CS, Rasmussen SA, Reefhuis J, et al. 2011. Maternal treatment with opioid analgesics and risk for birth defects. American Journal of Obstetrics and Gynecology, 204(4): 314.e1-314.e11.
  • Cole FS, et al. 2017. The Genomics of Neonatal Abstinence Syndrome. Front Pediatr. 5:176
  • Committee on Drugs, American Academy of Pediatrics. 2001. The transfer of drugs and other chemicals into human milk. Pediatrics; 108:776-89.
  • Daud AN, Bergman JE, Bakker MK, et al. 2015. P-glycoprotein-mediated drug interactions in pregnancy and changes in the risk of congenital anomalies: a case-reference study. Drug Safety, 38(7):651-659.
  • Interrante JD, Ailes EC, Lind JN, et al. 2017. Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Annals of Epidemiology, 27(9): Epub ahead of print.
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  • Ko JY, Wolicki S, Barfield WD, et al. 2017. MMWR Morb Mortal Wkly Rep Mar 10;66(9): 242-245.
  • Lind JN, Interrante JD, Ailes EC, et al. 2017. Maternal use of opioids during pregnancy and congenital malformations: A systematic review. Pediatrics, 139(6):e20164131.
  • Little BB, Snell et al. 1990. Maternal and fetal effects of heroin addiction during pregnancy. J Reprod Med 35:159-62.
  • Nygaard E, Slinning K, Moe V, Walhord KB. 2017. Cognitive function of youths born to mothers with opioid and polysubstance abuse problems during pregnancy. Chil Neuropsychol Feb; 23(2): 159-187.
  • Ostrea EM, Chavez CJ. 1979. Perinatal problems (excluding neonatal withdrawal) in maternal drug addiction: a study of 830 cases. J Pediatr 94:292-5.
  • Stone ML et al. 1971. Narcotic addiction in pregnancy. Am J Obstet Gynecol 109:716-23.
  • Stover MW, Davis JM. 2015. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol. 39(7):561-5.