A particularly heartbreaking aspect of New Jersey’s opioid epidemic is the growing need for effective care for pregnant women, new mothers, and newborn babies struggling to break free of a dependence on painkillers, alcohol or illicit drugs like heroin.
Yesterday, the state Department of Health launched a public education campaign to increase awareness about these painful facts, connect healthcare providers with proven treatment protocols for babies born exposed to these drugs, and help pregnant women who are under the influence of opiates learn about and connect with healthier options before they give birth.
The announcement builds on the state’s work with healthcare stakeholders to address this growing concern, with technical support from the federal Substance Abuse and Mental Health Services Administration dating back to 2014, and a number of clinical initiatives well underway. In November, former Gov. Chris Christie directed $5 million to nonprofit organizations to expand addiction treatment for pregnant women and new moms, part of some $200 million in programs he outlined in his final months in office.
But as the opioid crisis swells, so does its impact on maternal health: Since 2008, New Jersey cases of Neonatal Abstinence Syndrome (NAS) — which occurs when infants are exposed to drugs or alcohol in the womb — more than doubled to 685 babies in 2016, according to state statistics. Nationwide, there were enough NAS babies in 2012 for one to be born every 25 minutes.
Birth defects, withdrawal symptoms
“Babies that are exposed to drugs in the womb are at risk of prematurity, birth defects and withdrawal symptoms such as seizures and vomiting,” said health commissioner Dr. Shereef Elnahal. “By encouraging pregnant women to seek help, their addiction can be treated to reduce the impact to their unborn child.”
Babies with this condition are more likely to suffer from respiratory issues and be low birth-weight, a condition that can cause lasting health problems. NAS usually appears several days after birth, when some infants begin to suffer from withdrawal, displaying tremors, high-pitched and continuous crying, trouble feeding, vomiting and fever, according to the DOH.
These cases also add cost to the healthcare system. NAS babies require an average of nearly 17 days in hospital — more than eight times the normal for newborns — and cost healthcare facilities $1.5 billion in 2012, according to a federal study cited by the DOH. More than 80 percent of these claims were through Medicaid, funded jointly by the federal and state government.
To improve outcomes, the DOH is placing ads and social media messages encouraging women of child-bearing age who are using illegal drugs — or painkillers prescribed by a physician — to talk to a maternal care expert and get treatment. It is also distributing posters to local health departments, clinics, and other maternal care facilities.
Elnahal also sent a letter, endorsed by a number of key maternal care groups, to providers that flags the issue and shares best-practice guides and other clinical resources. The department also launched a website with other information for providers.
The campaign comes as government officials and healthcare leaders have increasingly focused on broader issues around maternal-child health; New Jersey has a maternal mortality rate well above the national average and while infant mortality has declined, black babies die at three times the rate of white newborns, statistics show.
Affected babies need special care
One goal of the DOH’s NAS-related promotion is to help birthing facilities offer affected infants the best possible care. Treatment for the baby depends on many factors, but some can benefit from careful swaddling, a dark, quiet nursery, and other efforts to reduce stimuli. Some also need intravenous fluids or to be tapered off the opioid they were exposed to while in the womb.
The effort also aims to connect pregnant women who have substance-use disorders (SUDs), or a dependence on legal pain pills, with treatment for their addiction long before they give birth.
Research has shown that Medication Assisted Treatment — prescribed medicines that help curb cravings and reduce addictive behavior, now considered the “gold standard” of care — is safe for both mothers-to-be and their unborn babies. This protocol also reduces the chance of a potentially deadly early withdrawal, which can trigger seizures, and exposure to other conditions, according to information compiled by the Central Jersey Family Health Consortium.
Robyn D’Oria, a nurse and CEO of the consortium, which is one of several organizations that signed on to Elnahal’s letter, said when pregnant women connect with treatment, they improve their chances of having a healthy baby. Even if the newborn still requires weaning from the prescribed MAT, some of which include opioids, the process is easier and presents fewer risks than illegal drug use, she said.
Treatment before the birth is key
“What we do know now is that both mom and baby are better off, as far as patient outcomes” when mothers get proper treatment in advance, D’Oria said. “And when moms try to withdraw themselves, it can have dire consequences.”
“It’s important for people to know there are resources out there, not only for the baby, but for mom,” D’Oria added, noting that even mothers who are prescribed painkillers legally need to know “that doesn’t mean it can’t have an effect on the baby.”
The DOH has several ongoing efforts also designed to assist providers address helping infants born with NAS — a situation that hospitals across the state face, maternal health leaders said. A technical assistance program is available to help healthcare, social welfare, and other stakeholders in developing practice guidelines for all aspects of treatment, from the mother’s pre-pregnancy to the early childhood of her offspring. The state is also funding “wrap-around” programs that provide comprehensive care and recovery services for women who are pregnant up to one year after they give birth.
A number of hospitals and other healthcare organizations are also seeking to improve care for pregnant women with addictions. Children’s Specialized Hospital, in New Brunswick, launched a comprehensive program nearly four years ago. The Camden Coalition of Healthcare Providers, a collaborative that serves some of the most vulnerable city patients, has incorporated this approach in its Camden Delivers, a program that connects pregnant women with prenatal care, plus services to address homelessness, addiction and other chronic illnesses and social concerns.
“Addiction has powerful impacts on moms, newborns and entire communities, and its roots are usually just as widespread and complex,” said Laura Buckley, senior program manager for Camden Delivers, noting that pregnant women struggling with SUDs often face multiple social challenges. “To break the cycle, and give that newborn a healthy start, it’s important to address the mother’s complex health and social needs, and not just the addiction,” she said.