Nurse practitioner Alane O’Connor goes out with a mobile outreach team a few times a month to check on some of her pregnant patients. Brianna Soukup/Staff Photographer

The number of substance-exposed babies in Maine has fallen to its lowest levels in more than a decade, declining from a high of 9.3% of all babies born in 2016 to 6.6% in 2023, according to state data collected from hospitals.

But while they welcome the trend, state leaders and those who care for the babies are not declaring victory over an especially troubling part of the opioid epidemic: newborns who go through withdrawal in neonatal intensive care units.

Symptoms of babies who were exposed to opioids, such as heroin or prescription painkillers, include tremors, muscle cramping, excessive crying, seizures, slow weight gain, poor sleep and eating, vomiting, and diarrhea.

“We’re still trying to figure out why the numbers are down,” said Alane O’Connor, a nurse practitioner with MaineHealth who researches the topic and heads up the MaineMOMS program to connect pregnant women with substance abuse treatment, postpartum care and other resources.

Data collected by the state indicates that fewer newborns have been exposed to all substances, including marijuana, opioids and other drugs. That overall data may be flawed, however, because hospital reporting of marijuana-exposed babies has been inconsistent since the drug was legalized in 2016.

However, recently published research on opioid use by pregnant women confirms there has been a substantial decrease in the numbers of babies born to mothers who used opioids while pregnant. That number peaked in 2017 after a sharp, decadelong increase.

That decline in the number of opioid-exposed babies comes as drug overdose deaths in Maine declined in 2023 for the first time in five years, from 723 deaths in 2022 to 607 in 2023.

But O’Connor said those positive trends do not mean overall opioid usage has declined.

One of the main reasons opioid deaths have decreased is the increasing availability of the life-saving antidote naloxone, experts have said. And O’Connor said substance-exposed births may be down because of “better access to long-acting, reversible contraceptives. We are having fewer unintended pregnancies.”

The long-acting contraceptives are easier to use than birth control pills because they don’t require women to remember to take a pill, she said.

Gordon Smith, Maine’s opioid response director, said the state has devoted resources to helping mothers and pregnant women with substance use disorder. But it’s not clear yet whether there’s a true decline in substance-exposed babies, because there may have been overreporting of substance-exposed infants several years ago, he said.

“But it’s gratifying to see these numbers decline, and we’ve continued to see a decline in total overdoses and fatal overdoses,” Smith said.

And despite the recent declines, the number of substance exposed infants is still much higher than the mid-2000s, when it stood at about 1.5% of deliveries.

But Smith said one problem with the data on overall exposures is that hospitals used to routinely include marijuana in their reporting of substance-exposed infants, but some of them have stopped reporting that data since recreational cannabis was legalized in Maine in 2016.

“Relying completely on the hospital data is really problematic because of the inconsistency with how the hospitals report marijuana use,” Smith said. He said state leaders are discussing how best to address the issue; whether, for instance, to recommend that all hospitals report or exclude marijuana use.

Based on the data reported to the state, 362 marijuana-exposed babies were born in Maine in 2023 – more than the 255 babies exposed to opioids, methamphetamine or other drugs.

National studies are showing more marijuana use among pregnant mothers compared to about 20 years ago, but there is no long-term data on substance exposed infants in Maine regarding marijuana use.

The effects of marijuana exposure on babies is not as obvious or well understood as the effect of opioids. O’Connor said marijuana use does impact a fetus’s central nervous system, but there’s much that is unknown. Some research indicates a risk of low birth weight for marijuana exposed infants, hyperactivity and other cognitive issues. Health experts recommend against marijuana use during pregnancy.

“We are more aware (that the) cannabis people are using now is much stronger, which makes it hard to rely on previous studies,” O’Connor said. “But we are trying to reduce exposure to anything that can cause harmful effects to the fetus.”

While the data is not clear about whether cannabis exposure is increasing or decreasing, O’Connor co-authored a study that confirms the number of infants exposed to opioids has declined from a peak in 2017.

The study, which was published in the Journal of Perinatology in January, isolated opioid use disorder among Maine women at the time they gave birth.

The number declined from a high of 39.3 per 1,000 hospital deliveries in 2018 to 18.8 in 2022, the latest year data is available, according to the research.

“The numbers are clearly down,” O’Connor said.

Another factor might be that women who gave birth a few years ago to a substance exposed infant may have since gotten into treatment and were not using substances for subsequent births, or had better access to contraception and avoided unintended pregnancies.

Also, according to the study, “rates of maternal (opioid use disorder) in Maine have tended to be higher among older women (25-34 years old) Therefore, a recent decrease in maternal (opioid use disorder) may be due to these women aging out of their reproductive years and no longer having children.”

There is no robust federal data on how many babies are born substance exposed, but national surveys indicate it’s about one of every 12 births. 

Dr. John Hagerty, lead physician and medical director of Northern Light Eastern Maine Medical Center’s neonatal intensive care unit, said the hospital is seeing fewer infants exposed to any substance, and that infants who do receive treatment and are released to a supportive home can thrive.

Many infants who are born substance exposed are also born prematurely, which can add another risk factor and often causes health complications in the first few months of life. Hagerty said that with proper care, the babies can do well – once they get through the withdrawal process.

“The vast majority do quite well,” Hagerty said. “But they can demonstrate opiate withdrawal for months.”