Drug

Sep 21, 2023

Brenda Iliff, Vice-President of Clinical Services at Rosecrance Jackson Centers, talks about the addictions that they see in mothers and their infants.

SIOUX CITY — The number of drug-exposed babies born at Sioux City hospitals over the last decade has been a growing concern for health officials.

"It's just continually getting worse," said Michelle Lewis, director of health promotions and population health for Siouxland District Health Department.

The health department and several community partners recently teamed up to create educational materials that highlight the harmful effects of using certain substances while pregnant, including methamphetamine, marijuana, nicotine, alcohol and prescription opioids. The brochures are being distributed to doctor's offices.

And, in late July, the health department began sharing short videos on its social media accounts from Dr. Ira Chasnoff, a Chicago pediatrician and expert on the effects of both legal and illegal drug use during pregnancy.

"We decided to really kind of focus on this and see what we can do to hopefully start decreasing the number of drug-exposed babies," Lewis said.

The number of drug-exposed babies born in Sioux City hospitals increased 105% between 2014 and 2015 alone. Eighty-six infant drug exposures were recorded in 2015, up from 42 the year before. In 2012, just 10 were tallied.

Infant drug exposure totals have remained relatively steady since the dramatic increase in 2015, dipping only into the 60s in 2018 (65) and 2022 (62), according to data provided by Siouxland CARES. Siouxland CARES is a coalition focused on improving the quality of life in Siouxland by eliminating the abuse of alcohol and other drugs.

"I think that there's a lot of socioeconomic struggles, particularly in our community, that puts a lot of women at risk," said Dr. Kortany McCauley, who specializes in neonatology and practices at UnityPoint Health -- St. Luke's. St. Luke's became Sioux City's lone labor delivery hospital after MercyOne Siouxland Medical Center discontinued obstetrics services in September 2020.

Since there are limitations on how long drug testing can detect certain substances, Brenda Iliff, vice president of clinical services for Rosecrance Jackson Centers, contends the actual number of newborns exposed to alcohol, marijuana, methamphetamine and other drugs is actually much higher than what is being reported.

For example, no babies born at Sioux City hospitals have tested positive for alcohol since 2009, when there was just one, according to the data.

Iliff said it's common for patients entering treatment at Rosecrance Jackson to be using "alcohol, marijuana and something."

"Alcohol, it's generally three days max, unless you're doing hair. Marijuana, the average is 30 days because of the fat in the system," she said of how long drugs can be detected in the body.

McCauley said St. Luke's has a policy in place that determines when mothers and babies are screened for drugs.

Mothers who have a history with the Department of Human Services are tested, as well as their babies, according to McCauley. She said any mom who has a placental abruption is automatically screened, as the complication has been linked to cocaine use.

"If there's things with the pregnancy that are kind or red flags, like let's say mom has had poor prenatal care or late presentation to care. We don't have her records on file. That's kind of concerning. If there's anything in mom's history that happens, those babies get screened," she said.

McCauley said urine, meconium, or earliest stool, as well as a segment of an umbilical cord, can be tested for drugs.

"Every baby has a part of their umbilical cord saved in case we need to retrospectively come back in and check the baby," she explained. "Babies can present with signs of withdrawal a little bit later, so we might not see signs of withdrawal until day three through five."

In some cases, close swaddling and using certain feeding techniques can help sooth a baby who was exposed to drugs, according Dr. Kortany McCauley, who specializes in neonatology and practices at UnityPoint Health -- St. Luke's.

Withdrawal symptoms depend on the drug the baby was exposed to. McCauley said poor feeding and decreased wakefulness have been observed in infants who have been exposed to selective serotonin-reuptake inhibitors, commonly used antidepressants, while jitteriness, poor feeding and high pitched crying are signs of opioid exposure.

"They're acting like they're hungry, but they're turning their head a lot and they'll get rub burns on their chin," she said. "Diarrhea, sweating -- those kinds of things are all concerning."

At St. Luke's, McCauley said they try to keep mom and baby together, if possible. Depending on the drug involved, close swaddling and using certain feeding techniques can help soothe the baby. Babies who were exposed to opioids and displaying withdrawal symptoms would receive care in the hospital's NICU, for example.

"We use morphine here as a first-line agent. That's pretty common across the U.S. You treat an opioid with an opioid," said McCauley, who did her fellowship training at Mayo Clinic and has worked at St. Luke's since 2020. "I had a baby that was very symptomatic from alcohol, which is a benzodiazepine. What can I treat that baby with? And, so, you kind of get into murky waters."

Marijuana is most commonly detected in babies born at Sioux City hospitals, followed by amphetamines, including methamphetamine.

Marijuana accounted for 63% of positive tests in 2022, down slightly from a high of 67% in 2016. Thirty-five percent of positive tests detected meth/amphetamines in 2022, down from 43% in 2021 and 40% in 2020.

Lewis said she noticed the number of drug-exposed babies being born at Sioux City hospitals begin to tick up at a time when a growing number of states were legalizing marijuana. Colorado and Washington were the first states to do so in 2012. Currently, 23 states and Washington, D.C., have legalized the recreational use of marijuana.

"We're only assuming that, potentially, if it's legal, they don't think it's a harmful substance to use," Lewis said. "We don't have any real reason as to why the data increased."

Iliff said the stigma surrounding marijuana use has decreased, but its potency has "increased significantly."

"With women, especially, psychosis, extreme anxiety can be a side effect of marijuana, nowadays, versus years ago it wasn't," she said.

McCauley said newborns who have been exposed to marijuana don't display the "classical signs" of drug exposure.

"I think the concern about marijuana is, as time moves forward, there will be more research done and we'll know the ramifications of prenatal exposure," she said. "I think the biggest concern is that there will be neurodevelopmental outcomes -- how they're going to do in school on standardized testing, but also behavioral issues, like ADHD. There's just still a big question about what marijuana does to the infant."

A brochure from the health department's public education campaign states that THC, the main psychoactive compound in marijuana, affects fetal brain development, which can result in poor cognitive function and other long-term consequences. It notes that THC can lead to low birth weight and premature birth.

McCauley said methamphetamine negatively affects babies' blood vessels. She has seen infants who have been exposed to meth suffer severe brain bleeds or stroke-like symptoms.

"Sometimes, they have no symptoms and, sometimes, you have the jitteriness. I think, ultimately, the long-term outcomes, neurodevelopmental effects are the biggest concerns," she said.

The health department's brochure states that illicit drugs, including methamphetamine, pose health risks for both mom and baby. Stillbirth, miscarriage and premature birth are potential dangers of prenatal illicit drug exposure. Other risks include infections and anemia in mothers, as well as growth defects, low birth weight, sudden infant death syndrome, and cognitive and behavioral problems in babies.

Brianna Steffe, unit coordinator for residential women's services at Rosecrance Jackson Centers, said some women enter drug treatment before they give birth. Others test positive for drugs at the hospital and are referred to treatment services.

The Iowa Department of Human Services typically doesn't recommend inpatient treatment for women whose babies test positive for THC, according to Steffe. Instead, they are referred to outpatient services. However, Steffe said an inpatient treatment referral is "automatic" when methamphetamine is detected.

Brenda Iliff, Rosecrance Jackson Centers' vice president of clinical services, left, and Brianna Steffe, unit coordinator for residential women's services, are shown at a crib in the agency's daycare. Iliff and Steffe say the number of babies who have been exposed to addictive substances is likely much higher than current data indicate.

Steffe said it's typical for pregnant women entering treatment to have foregone prenatal care because "they don't want doctors to know" that they've used drugs.

"They want help, but they also don't want the Department of Health and Human Services in their lives. So, they're trying to get into treatment so they don't test positive," she said. "I would say they're here because they really want to stop. It's not just trying to get out of the system or dodge the system. They want to be sober."

Iliff said Rosecrance Jackson has kept pregnant women in inpatient treatment for a longer period of time "just so they stayed safe to have the baby." She said anti-craving medications could be provided to pregnant women in treatment under the guidance of a physician.

"They would be in treatment even longer than the others. But they're in a safe environment. It protects the baby from mom having a relapse," she said.

Steffe interjected, "We just had one. She gave birth last week. She wanted to be discharged and graduated from inpatient treatment before she had the baby, and the recommendation was halfway house. So, she stayed with us. She has her baby with her and, as far as I know, no involvement with the Department of Health and Human Services because the baby did not test positive."

Pregnant women in inpatient treatment at Rosecrance Jackson are "very isolated from the outside world," according to Steffe, who said they are transported to all of their OB appointments. She said staff members secure diapers, cribs, baby wipes, formula and any other supplies the women might need. The babies stay with their mothers at the treatment center after birth. Rosecrance Jackson also has a daycare on site.

Iliff said the cravings and obsessions that go along with addiction are so intense that it's "almost impossible for most people to get off the chemicals without some sort of help." She said addiction is so powerful that it "supersedes people's values."

"Addiction is addiction, and it doesn't care if you're pregnant, or if you're not pregnant, or if you're a mother of 10," she said. "Once you cross that line into addiction, you cross the line of choice."

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