Research on the Risks of Kratom Use During Pregnancy

During pregnancy, doctors encourage expectant mothers to refrain from consuming a number of things they may normally consume in their daily lives, including deli meats, soft cheeses, tobacco, alcohol, and high levels of caffeine. 

Occasional and habitual kratom users should stop using kratom during pregnancy, due to risks to their own health as well as that of their developing fetus. Even if someone has used kratom without any complications, the risks of kratom use during pregnancy are too significant for continued use. 

Kratom, maternal dependence, and Neonatal Abstinence Syndrome

Alice Ordean from the Department of Family and Community Medicine at the University of Toronto published a study in 2023 that reviewed the literature on prenatal kratom exposure and its effects on both mothers and infants. 

Ordean found: 

• Regular maternal kratom use during pregnancy could lead to physical dependence and withdrawal symptoms in mothers and newborns alike
• Many infants exposed to kratom in utero experienced Neonatal Abstinence Syndrome, a condition characterized by withdrawal symptoms caused when an infant’s body is no longer receiving certain drugs from its mother’s consumption
• Kratom might cause intrauterine growth restriction, which leads to babies with the classification of small for gestational age (SGA)
• Low birth weight was reported in about 25% of infants exposed to kratom in utero

This overview emphasizes the need for additional research into kratom use during pregnancy, especially for women who have been using kratom as an opioid addiction management tool. 

Symptoms of NAS

The March of Dimes provides funding, programming, and educational resources to help babies and women. They explain the signs of Neonatal Abstinence Syndrome: 

• Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
• Fussiness, excessive crying or having a high-pitched cry
• Poor feeding or sucking or slow weight gain
• Breathing problems, including breathing really fast
• Fever, sweating or blotchy skin
• Trouble sleeping and lots of yawning
• Diarrhea or throwing up
• Stuffy nose or sneezing

The March of Dimes also explains that NAS is associated with risks like low birth weight, jaundice, seizures, and SIDS. Long-term risks include developmental delays, motor problems, speech and language problems, sleep issues, ear infections, and vision problems. 

Kratom and opioid withdrawal symptoms in pregnant women

Because kratom use is unsafe in pregnancy, some women will make the wise decision to stop kratom use. However, regular kratom users may face opioid withdrawal symptoms upon cessation. 

A 2018 study from Smid et. al presented the cases of two pregnant women who were experiencing symptoms of opioid withdrawal. Although kratom does not commonly cause opioid withdrawal, individuals who are dependent upon kratom can experience withdrawal symptoms upon cessation, and even life-threatening effects. 

The women in the Smid study were provided with an opioid replacement medication that allowed them to safely detox from kratom. The authors concluded that because kratom is emerging as a self-treatment for opioid use disorder (OUD), obstetricians should familiarize themselves with kratom and know how to treat pregnant patients who are dealing with dependence and withdrawal. 

Neonatal kratom withdrawal doesn’t show up on traditional toxicology screens

As a widely legal and accessible product throughout most of the US, kratom is not included on most toxicology screens. This poses a potential risk because it can be difficult to identify why an infant is experiencing withdrawal symptoms from kratom without parental disclosure or a positive toxicology result. 

This concern was documented in Davis et. al’s 2019 article in the Journal of Perinatal Medicine, which reported on the impact of kratom on a newborn who required treatment with opiates after exhibiting symptoms of neonatal drug withdrawal. 

The authors recommended that physicians should be aware of kratom and its potential impact on infants.

Frequency of NAS symptoms among newborns

Wright et. al’s 2021 study reviewed 5 case reports that discussed 6 mother-infant pairs. 

The research found that mothers were most likely to use kratom for pain relief, anxiety, desired opioid-like effects, and management of opioid withdrawal symptoms. The studies found that these women documented withdrawal symptoms that were very similar to opioid withdrawal while discontinuing kratom use. 

Unfortunately, 5 out of the 6 infants exhibited neonatal abstinence syndrome (NAS) symptoms, and most of them required pharmacological treatment with morphine to treat their NAS.

The researchers recommended improved screening for kratom use during pregnancy, the development of clinical management strategies for maternal kratom use, and better management of infant withdrawal symptoms. 

Kratom and breastfeeding

There is very little research, if any, on kratom and breastfeeding. 

However, the Infant Risk Center at the Texas Tech University Health Sciences Center says:

Based on what we know about the chemistry of Mitragynine and 7-hydroxymitragynine in Kratom, some degree of transfer to the milk and to the unborn fetus can be expected. The extent of the effects of maternal Kratom consumption on the unborn fetus and breastfeeding infant is unknown. Moreover, there are numerous other compounds that Kratom contains that may be of concern.

The safety of Kratom in pregnancy and lactation has not been studied and we would not recommend the use of this product in pregnant or breastfeeding women. Most importantly, because Kratom products are not regulated, the risks of consuming contaminated and/or adulterated products significantly outweigh any potential benefit in this population. Pregnant or breastfeeding women who are using Kratom are encouraged to inform their healthcare providers and they should wean off these products.

Resources for pregnant kratom users

Kratom users who become pregnant have options for stopping their kratom use. Because kratom does not cause withdrawal symptoms for most users, the majority of pregnant people can likely stop using kratom without any issue upon learning of their pregnancy. 

Kratom’s addictive qualities are sometimes likened to the addictiveness of coffee, meaning that people who drink a lot of coffee every day are more likely to have withdrawal symptoms and difficulty giving up coffee than casual coffee drinkers. Similarly, kratom consumers who use it heavily or on a daily basis are more likely to struggle with giving it up. 

If someone is struggling to quit kratom while pregnant or in anticipation of becoming pregnant, resources include:

• Speaking with your OBGYN about your kratom use and desire to stop during pregnancy
• Contacting SAMHSA, a federal agency with a confidential helpline that can connect you with local resources for quitting
• Researching local addiction recovery organizations in your area

Should you tell your doctor about your kratom use? 

It is always a good idea to disclose the use of any drugs or herbal supplements to your medical provider, especially during pregnancy. The more your healthcare provider knows about the substances you use, the more effectively they can provide appropriate care. 

You may be wondering, what if kratom is illegal in your state? Will you get in trouble? 

In most states, kratom is completely legal, although there may be age limits on the substance. There are no legal risks to disclosing kratom use to doctors in those states. Meanwhile, six states have total bans on kratom: Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin. In those states, kratom is categorized as a drug instead of an herbal substance. 

The good news is that doctors are very rarely required to disclose substance use to the authorities. When you share your kratom use with your doctor, it is covered by HIPAA unless there are unique circumstances like the doctor receiving a court order for drug test results or you are engaging in self-harm behaviors that put you or someone else at risk. 

Because of the potential risks to yourself and your developing fetus, doctors and addiction services providers recommend speaking to your doctor about your kratom use during pregnancy. 

Sources

• Davidson, L et al. “Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to ‘kratom’.” Journal of Neonatal-perinatal Medicine vol. 12,1 (2019): 109-112. doi:10.3233/NPM-1863
• Illinois Recovery Center. “What Happens If Doctors Find Drugs in Your System?” IllinoisRecoveryCenter.com. 12 Jul. 2024.
• Infant Risk Center. “Kratom.” Texas Tech University Health Sciences Center. 20 Feb. 2017.
• “SAMHSA’s National Helpline.” SAMHSA.gov. N.d.
• “Neonatal Abstinence Syndrome.” March of Dimes. Jun. 2019. 
• Ordean A. “Antenatal Kratom Exposure: Literature Review and Clinical Management Recommendations. Research and Reports in Neonatology.” 2023;13:15-21 https://doi.org/10.2147/RRN.S419864
• Settle, Austin G, and Chong Yang. “A Case of Severe Kratom Addiction Contributing to a Suicide Attempt.” Cureus vol. 14,9 e29698. 28 Sep. 2022, doi:10.7759/cureus.29698
• Smid, Marcela C et al. “Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy.” Obstetrics and Gynecology vol. 132,4 (2018): 926-928. doi:10.1097/AOG.0000000000002871
• Smith-Slade, Dayna. “Why It’s Important To Be Honest About Substance Use With Your Doctor.” AddictionCenter.com. 5 Aug. 2024.
• Wright, Mary Ellen et al. “Outcomes of Mothers and Newborns to Prenatal Exposure to Kratom: A Systematic Review.” Journal of Perinatology: Official Journal of the California Perinatal Association vol. 41,6 (2021): 1236-1243. doi:10.1038/s41372-021-00952-8