ESCANABA — There has been concern in the community about the percentage of babies born drug-dependent. In 2016, Dr. Mark Povich, DO, of OSF HealthCare St. Francis Hospital and Medical Group in Escanaba ,began compiling detailed information for a yearly report. He found there was an issue, but the numbers were not as high some people in the community thought.

Looking at data from April 1, 2018, to March 31, 2019, the report titled Neonatal Substance Exposure, a year worth of monitoring 292 mothers and their 293 newborns revealed 18 percent of newborns delivered in Delta County were exposed to illegal drugs or marijuana in utero at some point during their mother’s pregnancy. The number of drug exposed newborns is slightly up from the previous year, according to the same report by Povich.

A slight decrease was found for several substances including buprenorphine, opiates, benzodiazepines and meth/amphetamine, but an increase of 2.9 percent was found for marijuana. Cocaine and methadone percentages were constant, less than 1 percent.

About 82 percent of mothers did not have drugs in their system at the time they were tested during pregnancy.

While 18 percent of newborns were born exposed to a substance, only 3 percent of newborns were born experiencing withdrawal symptoms. One percent of all newborns born at OSF St. Francis Hospital required medication to treat withdrawal symptoms.

“In those cases, their withdrawal was so severe we needed to treat them with medication,” said Povich. “It is often the babies who have been exposed to buprenorphine that experience the worst withdrawal symptoms.”

Buprenorphine is a drug used in medication-assisted treatment to help people reduce or quit their use of heroin or other opiates. Pregnant women who are trying to come off certain narcotics, or street drugs, may have buprenorphine prescribed to them. Unfortunately, buprenorphine is sometimes abused and also available as a street drug. Though buprenorphine often causes the most severe symptoms of withdrawal, it can be seen with any substance a newborn is exposed to.

“If the mother has been taking something regularly during pregnancy, once the baby is born and no longer exposed to the substance, they will experience some form of withdrawal,” said Povich. “Just like the mother would if she were to quit using the substance abruptly.”

If a newborn acts as if they are dependent on drugs — problems feeding, sleeping, temperature regulation, shaking, seizures, general central nervous system hyper-irritability, respiratory distress — a Meconium Toxicology report may be reviewed. A sample of the baby’s first stool, called meconium, will be collected and tested in a lab. Of the newborns born at OSF St. Francis, 2.7 percent were found to have buprenorphine in their meconium and 7.5 percent had marijuana. This indicates the mother used during pregnancy. From last year, that is an increase of 1 percent of marijuana and a decrease of 1.5 percent of buprenorphine.

A baby’s withdrawal symptoms drive what treatment they get because each baby reacts differently.

“There are babies with zero symptoms, and babies with awful symptoms and then babies in between,” said Povich. “Babies in the 1 percent that required medication for their withdrawal symptoms are easy to identify. That are shaking, jittery, and they don’t rest or feed well. Even babies born to moms that are smokers … we can see a little withdrawal because they’re coming off the nicotine they’ve had during the last several months.”

The approach to detoxing babies is changing. There is a scoring system of symptoms. If a baby gets to a certain number, a certain level of severity, medication may be needed. Some babies with symptoms need to be transferred to a hospital with a neonatal intensive care unit where the baby is treated until detoxification is done.

“Treatment can last for weeks, and you can imagine the impact on families,” said Povich. “Because we don’t have a neonatal intensive care unit in our community we have alternative ways to treat these babies when appropriate.”

Typically at St. Francis Hospital methadone is used as an opiate to help a baby detox when they require medication.

“What we’ve been doing is starting them on medication in the hospital. We do supportive care things that keep them calm while we wait for their body to detox,” said Povich. “You want to let them down gently.”

Once the baby is determined to be stable, it is discharged from the hospital and sent home. If more treatment is required, home health workers will visit the home to administer methadone to the baby. The visits continue as the dose gets tapered down slowly until the baby no longer needs assistance.

There is emphasis on the risks of illegal drugs in our country, with messages coming from each level of government as well as medical organizations. A pregnant woman should remember whatever they eat, drink or smoke is passed to their baby and can affect the development of their baby.

Prenatal opioid exposure is tied to long term mental and physical health risks. Preschoolers born to mothers who took opioids during pregnancy had a higher chance of developing conduct disorders or emotional disturbances. Their growth rate slowed and the rate of attention-deficit hyperactivity disorder (ADHD) was high.

Harm caused to the developing fetus by a toxic agent is dependent on many factors, the baby’s genetic makeup, the fetal and postnatal environment, the dose of the drug, and at what stage of development the fetus was exposed to it. Damage to the central nervous system during the prenatal period continues to have effects through fetal, neonatal, infant, and childhood development. A central nervous system injury may result in behavioral impairments rather than physical birth defects, according to Povich’s report.

Povich is concerned what drug exposure will do to a child in later years and with the legalization of marijuana and how it might increase the number of babies exposed to marijuana while in the womb.

“Though it is now a legal substance, it does not mean it is any less harmful during pregnancy,” noted Povich.

Adults also experience health risks during withdrawal from drugs. Withdrawing while pregnant has even more risks as it impact both mother and baby.

“There are risks when detoxing from opiates during pregnancy so it is not something that obstetricians recommend without proper medical supervision,” said Dr. Michael Czerkes, MD, obstetrician and gynecologist at OSF HealthCare St. Francis Hospital and Medical Group. “Quitting opiates suddenly during pregnancy has not been shown to be safe or effective for mothers or babies during pregnancy. The relapse rate is very high and the baby would need to be closely monitored as pregnancy complications can occur.”

There is no one-size-fits-all approach to treatment and physicians determine treatment plans based on each individual patient and their circumstances. The objective remains the same for the mothers.

“The goal for mothers is long term recovery. Once they have engaged in therapy during pregnancy or before, the goal is to continue this therapy after the baby is born,” said Czerkes. “Long term recovery allows for more productive home and work life. We want to continue to work to stabilize and improve outcomes, as well as improve life for these families.”