Neonatal Abstinence Syndrome (NAS), also referred to as neonatal withdrawal syndrome, is a condition in which a newborn experiences withdrawal symptoms after being exposed to opioids or other addictive substances during pregnancy.
When the baby is born and the flow of the substance stops, their body reacts to the sudden absence, leading to a range of neonatal withdrawal symptoms such as tremors, irritability, or feeding difficulties.
Substances that can cause NAS include:
- Opioid medications (oxycodone, hydrocodone, morphine, methadone, buprenorphine)
- Illicit opioids (heroin, fentanyl)
- Certain antidepressants or sedatives (SSRIs, benzodiazepines)
NAS can also occur from polysubstance exposure, when multiple substances are used during pregnancy.
How Common Is NAS?
According to the Centers for Disease Control and Prevention (CDC), approximately 7 out of every 1,000 newborns in U.S. hospitals are diagnosed with Neonatal Abstinence Syndrome. This represents a sharp rise over the past 20 years as opioid misuse and prescription dependency have increased among women of reproductive age. States in the Southeast, including Tennessee and Georgia, have some of the highest rates of NAS newborn diagnoses.
Signs and Symptoms of Neonatal Abstinence Syndrome
The signs of neonatal abstinence syndrome usually appear within 24–72 hours after birth, but can be delayed up to a week depending on the drug and dosage involved.
Common NAS symptoms and neonatal withdrawal syndrome symptoms include:
| System Affected | Newborn Withdrawal Symptoms |
| Neurological | Tremors, irritability, high-pitched crying, increased muscle tone, seizures |
| Gastrointestinal | Poor feeding, vomiting, diarrhea, dehydration, weight loss |
| Autonomic | Sweating, sneezing, yawning, fever, unstable temperature |
| Respiratory | Rapid breathing, nasal flaring, shallow breathing |
| Sleep / Behavior | Trouble sleeping, excessive crying, restlessness, difficulty calming |
The intensity of NAS symptoms varies by substance, timing of last exposure, and maternal health during pregnancy.
NAS Scoring and Diagnosis
Clinicians use a standardized NAS scoring system, most commonly the Finnegan Neonatal Abstinence Scoring System, to assess symptom severity and guide treatment decisions. Each symptom (such as tremors, feeding difficulty, or respiratory distress) receives a score; the higher the cumulative total, the more intensive care the newborn may require.
Typical evaluation steps include:
- Continuous observation for at least 4–5 days after birth
- Scoring assessments every few hours
- Possible toxicology screening for confirmation of exposure
This NAS scoring process helps hospitals balance comfort-based care with appropriate medical intervention.
Treatment for Neonatal Abstinence Syndrome
Treatment for neonatal withdrawal syndrome focuses on relieving discomfort, supporting feeding and growth, and stabilizing vital signs.
Non-pharmacologic (comfort-based) treatment
- Swaddling, gentle rocking, and low-stimulation environments
- Skin-to-skin contact and breastfeeding when safe
- Soothing voice, soft lighting, and quiet spaces
Pharmacologic (medication-based) treatment
In moderate to severe cases, physicians may prescribe small, tapering doses of morphine or methadone to gradually ease withdrawal. The infant is then slowly weaned under medical supervision to prevent complications.
Aftercare and monitoring
After discharge, infants recovering from NAS often need:
- Pediatric follow-ups and developmental screenings
- Nutritional and feeding support
- Early-intervention therapy programs
- Family support and home-based services
How Maternal Recovery Impacts NAS Outcomes
The best way to reduce the risk or severity of NAS newborn withdrawal is through maternal addiction treatment during pregnancy. When pregnant women receive consistent care, especially through Medication-Assisted Treatment (MAT) programs with methadone or buprenorphine, both maternal and infant outcomes improve significantly.
Effective approaches include:
- Addiction treatment integrated with prenatal care
- Counseling and behavioral therapy for stress and trauma
- Peer recovery programs for pregnant and postpartum women
- Postpartum relapse prevention planning
Addiction During Pregnancy: Risks, Realities, and Pathways to Recovery
Addiction during pregnancy, sometimes called substance use in pregnancy, occurs when a person continues using alcohol, opioids, or other drugs while expecting.
This condition is complex and deeply stigmatized, yet it’s more common than most realize. According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 20 pregnant women report using one or more addictive substances, including prescription opioids or illicit drugs.
Addiction during pregnancy is not a moral failure. It’s a medical condition that requires understanding, evidence-based treatment, and a coordinated care plan that prioritizes both mother and baby.
How Substance Use Affects Pregnancy
Substances pass through the placenta to the developing fetus, and chronic exposure can affect fetal growth, brain development, and organ function.
The specific risks depend on the drug type, dose, frequency, and stage of pregnancy.
| Substance Type | Possible Risks to the Baby |
| Opioids (heroin, fentanyl, oxycodone, morphine) | Neonatal Abstinence Syndrome (NAS), low birth weight, premature birth |
| Alcohol | Fetal Alcohol Spectrum Disorders (FASD), brain and heart defects, cognitive impairment |
| Methamphetamine & Cocaine | Placental abruption, low birth weight, developmental delays |
| Benzodiazepines | Withdrawal symptoms, respiratory distress, feeding challenges |
| Nicotine or vaping | Restricted fetal growth, preterm delivery, SIDS risk |
| Marijuana | Lower birth weight, attention and memory problems, behavioral challenges |
These complications don’t happen in every case, but consistent exposure without medical supervision increases the risk of adverse outcomes.
Medication-Assisted Treatment (MAT) During Pregnancy
Quitting cold turkey can be dangerous for both the mother and the fetus. Instead, Medication-Assisted Treatment (MAT), using methadone or buprenorphine under a doctor’s care, is considered the safest and most effective approach for pregnant individuals with opioid use disorder. MAT stabilizes the mother’s withdrawal symptoms, reduces cravings, and decreases the risk of relapse, which in turn lowers the baby’s risk of severe NAS symptoms.
According to SAMHSA, MAT during pregnancy:
- Improves prenatal care adherence
- Reduces overdose risk
- Increases birth weight and gestational age
- Supports maternal mental health
These medications do not “swap one addiction for another”—they are evidence-based treatments that prevent physiological withdrawal while promoting long-term recovery.
Mental Health and Trauma in Pregnancy
Many women who use substances during pregnancy also experience depression, anxiety, trauma, or intimate partner violence. These underlying factors often drive addiction and can worsen if left untreated. Integrated dual-diagnosis care, addressing both mental health and substance use, offers the best outcomes for mothers and infants.
This includes:
- Trauma-informed therapy
- Safe, nonjudgmental counseling
- Peer support groups for pregnant or postpartum women
- Medical monitoring and nutritional guidance
When compassion replaces stigma, recovery becomes possible—even during pregnancy.
Addiction Treatment Options for Pregnant Individuals
Effective addiction treatment during pregnancy involves collaboration between addiction specialists, obstetricians, pediatricians, and mental-health professionals.
Common elements of comprehensive care include:
- Medical detox (only under close supervision)
- MAT programs for opioid use disorder
- Behavioral therapy such as CBT or DBT
- Prenatal and postpartum support groups
- Case management for housing, childcare, or legal challenges
- Education on neonatal abstinence syndrome (NAS)
Many recovery programs now provide family-centered care, ensuring that mothers, infants, and partners receive support together.
The Importance of Compassionate, Stigma-Free Care
Shame and fear of legal consequences often prevent pregnant individuals from seeking help. However, early treatment dramatically improves outcomes, and compassionate care saves lives. Hospitals and treatment centers increasingly work under “safe harbor” or “amnesty” policies, encouraging pregnant women to disclose substance use and access treatment without punishment.
Support begins with trust. Recovery begins with compassion.
Postpartum Addiction Recovery and Family Healing
The postpartum period is one of the most vulnerable times for relapse and depression among new mothers. At Brooks Healing Center, we understand that addressing addiction and emotional health together helps families break the cycle of substance exposure.
Our programs support:
- Postpartum depression and anxiety care
- Relapse prevention and stress-management techniques
- Family therapy and partner education
- Coordination with OB/GYN and pediatric teams
Preventing Neonatal Abstinence Syndrome
Prevention starts with compassionate, stigma-free care. Open conversations with healthcare providers about medication or substance use during pregnancy allow mothers to receive safer treatment alternatives and medical monitoring.
Key steps include:
- Early prenatal visits and regular checkups
- Medication-assisted treatment instead of abrupt cessation
- Integrated mental-health and addiction counseling
- Ongoing postpartum support to sustain recovery
Frequently Asked Questions About Neonatal Abstinence Syndrome
What are the first signs of neonatal abstinence syndrome?
Early signs of neonatal abstinence syndrome include high-pitched crying, tremors, feeding difficulty, and irritability within the first few days after birth.
Is NAS the same as neonatal withdrawal syndrome?
Yes. The terms are often used interchangeably to describe withdrawal symptoms in newborns after prenatal substance exposure.
What does NAS scoring mean?
NAS scoring is the process hospitals use to measure the severity of newborn withdrawal symptoms. Higher scores indicate more intense withdrawal and may require medication support.
Can babies fully recover from NAS?
Yes. With proper medical and developmental follow-up, most infants recover completely and go on to meet normal milestones.
Can mothers on methadone or buprenorphine breastfeed?
In many cases, yes—under a doctor’s supervision. Breastfeeding can soothe withdrawal and strengthen bonding when no illicit substances are being used.
How can addiction treatment help prevent NAS?
When expectant mothers receive medication-assisted therapy, prenatal care, and mental-health support, the chances of severe NAS decrease dramatically.
Can you safely detox while pregnant?
Not always. Abruptly stopping opioid or alcohol use can cause miscarriage or preterm labor. Medically supervised detox or MAT is the safest option.
Is medication-assisted treatment safe during pregnancy?
Yes. Methadone and buprenorphine are both approved by the FDA for use in pregnancy and are supported by leading medical organizations, including ACOG and SAMHSA.
What if I relapse during pregnancy?
Relapse is not failure—it’s a signal that more support is needed. Contact your healthcare provider immediately for safe re-stabilization options.
Can I breastfeed while in treatment?
In many cases, yes. Under medical supervision, breastfeeding is encouraged for women on stable doses of methadone or buprenorphine and not using illicit substances.
Where can I find support for addiction during pregnancy?
You can contact:
– SAMHSA National Helpline: 1-800-662-HELP (4357)
– Postpartum Support International (PSI): 1-800-944-4773
– Georgia & Tennessee Maternal Health Programs via local health departments
Sources
- Centers for Disease Control and Prevention. (2024). About Neonatal Abstinence Syndrome (NAS). https://www.cdc.gov/ncbddd/aboutus/nas.html
- National Institutes of Health. (2024). Neonatal Abstinence Syndrome (NAS): Clinical Overview. https://www.nichd.nih.gov/health/topics/nas
- Hudak, M. L., & Tan, R. C. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540–e560.
https://publications.aap.org/pediatrics/article/129/2/e540/31625/Neonatal-Drug-Withdrawal - American Academy of Pediatrics. (2023). Management of Neonatal Opioid Withdrawal Syndrome. https://pediatrics.aappublications.org/content/early/2023/03/15/peds.2023-057203
- Substance Abuse and Mental Health Services Administration. (2024). Treatment of Pregnant and Parenting Women with Substance Use Disorders.https://www.samhsa.gov/resource-search/ebp/ebp-resource/ebp_106
