The use of any supplement, medication, or drug is not recommended while pregnant or breastfeeding, because of lack of research on potential harm to your child’s developing brain and body. This includes kratom, as it is difficult to perform any rigorous studies of kratom or any drug on pregnant women due to ethics boards.
It’s not clear if alkaloids in kratom pass through the placenta from mother to baby. We do know other drugs, including heroin, morphine, methadone, and THC in cannabis do cross the placenta, so it’s likely kratom alkaloids do too. This means it is expected that kratom alkaloids, at some level, can bind to opioid receptors in your baby’s spinal cord and brain.
Neonatal abstinence syndrome
Neonatal abstinence syndrome (NAS) is commonly seen in babies born to mothers who used heroin, prescription opioids, other non-stimulant drugs during pregnancy. Not all babies will experience the same symptoms, as it is dependent on the type and total amount of drug the baby was exposed to.
Signs of NAS include:
- shaking, twitching, or seizures
- rapid or troubled breathing
- excessive crying
- excessive yawning
- vomiting or diarrhea
- trouble sleeping
- sweaty or blotchy skin
- rigid muscles
- stuffy nose or sneezing
When hospitals encounter babies with NAS symptoms, the gold standard is to treat them with decreasing doses of morphine until they are weaned off of opioids. This obviously has harms to the child, but less than going through potentially deadly withdrawal symptoms.
Increasing cases of NAS are seen with women who have been using kratom, which unlike other opioids, does not show up on a typical urine drug testing screen. But is the NAS truly from kratom?
In most NAS cases, the mother was using ridiculous large amounts of kratom or wasn’t just using kratom.1 Mothers were using other medications, including benzodiazepines, neuroleptics like gabapentin, and cigarettes.2,3 These drugs also can cause low birth weight or neonatal withdrawal symptoms. Combining these drugs with kratom can cause drug-drug interactions that may be even more detrimental to the fetus.
Other possible negative birth outcomes
Kratom use during pregnancy may cause other complications even if NAS is not experienced by your child. Studies of children born to mothers who used other opioids like heroin or morphine experienced stillbirth, low birth weight, preterm delivery, and increase cesarean section delivery.4 Because kratom alkaloids are less potent that other opioids, it is possible that these pregnancy outcomes will be less severe or nonexistent in kratom users. Birth defects with opioids are not reported, and are not expected with kratom use.
Supporting pregnant mothers who use kratom
It is not clear whether using kratom at low doses during pregnancy results in NAS or other negative pregnancy outcomes. It’s important to not pass judgement on mothers who use kratom, as many mothers are not healthy before they get pregnant. Some mothers have chronic pain conditions like fibromyalgia, and have to make calculated decisions on whether opioids or kratom are safer during pregnancy. For these moms, kratom may be the safer option, and should be counseled on harm reduction.
As a healthcare provider, you may be angry if you find your patient is trying to hide their kratom use from you. Remember that mothers are afraid their healthcare provider will call Child Protective Services (CPS) and take their child away from them for being a negligent mother. Anecdotally, there are thousands of mothers, many with chronic illness, who have used kratom during pregnancy with mild if any withdrawal symptoms seen in their babies.5 Ask yourself if calling CPS on a kratom using mother is the right thing to do before you do so.
Need more kratom science?
To learn more about the potential risks and benefits of using kratom, check out Kratom Is Medicine, the new book from AURA Therapeutics founder Dr. Michele Ross.
- Mackay L, Abrahams R. Novel case of maternal and neonatal kratom dependence and withdrawal. Can Fam Physician. 2018;64(2):121-122.
- Davidson, L. et al. ‘Natural Drugs, Not so Natural Effects: Neonatal Abstinence Syndrome Secondary to “kratom”’. 1 Jan. 2019:109 – 112.
- Smid MC, Charles JE, Gordon AJ, Wright TE. Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy. Obstet Gynecol. 2018 Oct;132(4):926-928.
- Yazdy MM, Desai RJ, Brogly SB. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. J Pediatr Genet. 2015 Apr 1;4(2):56-70.