Like people in general, pregnant people use non-prescribed drugs for many reasons. Opioids and stimulants are increasingly popular, as well as marijuana. Kratom, a species of tree from Southeast Asia, is possibly also being used more frequently during pregnancy. This has raised concerns from healthcare workers—but evidence suggests that these concerns are being distorted and overblown by media and government.

    Kratom’s leaves are usually brewed as a tea. The organic chemicals contained can give stimulating or opioid-like effects, which advocates call life-saving and the federal government labels addictive and dangerous. A Schedule I ban seems imminent, which would likely devastate the estimated 5 million kratom users in America and deepen the US overdose crisis.

    The effects of kratom on pregnant people and their babies are largely unknown. Before 2017, one of the few mentions of kratom use during pregnancy was a single paragraph buried in a retrospective report from a poison center in Thailand, describing a two-day old infant experiencing withdrawal symptoms. The child improved with “supportive treatment,” although it’s not clear what that means.

    In the last two years, however, at least six case studies of pregnant kratom use, totaling seven infants in North America, have been published. The newborns in these reports exhibited symptoms consistent with opioid withdrawals. For example, in one of the earliest reports, “The baby had breathing difficulties, irritability, jitteriness, muscle hypertonicity, and a high-pitched, inconsolable cry.” Another report claimed it is “vital” that healthcare workers be aware of kratom’s potential impact on maternal and infant outcomes.

    Notably absent from these government agency positions and media narratives—and from most of the case studies—are the voices of pregnant people themselves.

    Because two chemicals in kratom, mitragynine and 7-hydroxymitragynine, are “atypical” opioids and have potential for problematic use, the drug was implicated as the cause of these side effects. In all of the cases, the babies were stabilized using morphine or another opioid, and kratom did not seem to cause any long-lasting, damaging effects, although it’s hard to be sure without long-term follow-up.

    These micro-scale studies have spawned numerous media reports, from CNN to Fox to CBS, proclaiming that doctors are “sounding the alarm” about “horrifying” withdrawal symptoms. Yet virtually no data show kratom use during pregnancy to be harmful, and there is no established link between kratom and neonatal abstinence syndrome. A 2013 review simply recommended that pregnant people avoid kratom “due to a lack of sufficient data.”

    Lack of evidence of safety is not evidence of harm. But the Drug Enforcement Administration seems to have made up its mind. In 2016, the agency announced intent to schedule kratom, making it highly illegal. Due to public backlash, including from several congressmembers, the DEA backed off, in an unprecedented move.

    But the agency then reached out to the Food And Drug Administration for scientific review. This was completed, and a DEA decision is now pending. The FDA has issued a series of attacks on kratom, attributing multiple deaths to the herb, although researchers have disputed the interpretation of this data. In a statement to CNN, FDA Commissioner Scott Gottlieb described kratom pregnancies as “a tragic case of harm.”

    “What’s important to remember is that there are no scientific data from studies of kratom in humans. Kratom is an inherently addictive product that can cause harm, and it has no demonstrated medical benefit,” an FDA spokesperson tells Filter in an email. “The FDA continues to urge consumers not to consume kratom for any purpose [including pregnancy] and urges those who may be addicted to the opioid kratom to seek help from their healthcare provider.”

    Notably absent from these government agency positions and media narrativesand from most of the case studiesare the voices of pregnant people themselves. To learn more, I reached out to multiple women who have used kratom during pregnancy, as well as a couple of experts.

    Experiences of Women Who Use Kratom While Pregnant

    With no epidemiological data on kratom and pregnancy, we have no idea of the number of pregnant people using the drug. Kratom’s metabolites don’t appear on standard drug tests, so unless users tell their OB/GYN they take it, their use will probably go unnoticed. Many mothers are reluctant to report drug use to their doctors, even legal drug use, for fear their kids will be taken away by Child Protective Services.

    “Women have a hard time coming forward about this information and that’s why it’s hard to find it out there,” says Barbara*, a 32-year old mother of three and kratom user from the US, who asked me not to share her location.

    About three years ago, Barbara started a private social media group to help kratom-using moms connect. Today, the group has around 2,500 members. The vast majority began using kratom to replace pharmaceuticals, especially buprenorphine, a drug used to treat opioid addiction. (Unlike with kratom, there is relatively clear evidence that buprenorphine can cause withdrawals in newborns.)

    Barbara says that hundreds of birth stories have been shared in the group. “Almost all of the birth stories, the babies are born perfectly healthy without any issues at all,” she tells me on the phone. “But there are a very small percentage, about 3 percent, that have mild withdrawal symptoms. Of those cases, about half of those the moms were taking other medications and those medications have the same possible side effects, so we do not know whether it was kratom or the other medication. And in those cases if it was withdrawal, it was very mild. In almost every case it just included fussiness and sneezing, which ended on the third day.”

    “We’ve had about 150 people contribute to that poll, and all of them say that their kids have either met their milestones or are ahead of their milestones.”

    Barbara herself began taking kratom to replace gabapentin, an anti-seizure medication she was using to manage breathing attacks that sometimes cause her to collapse. During her second pregnancy, she initially quit kratom. But her expanding uterus began pressing against her lungs, causing her pain, so she resumed kratom use as needed, usually once every other day.

    Barbara’s daughter, who is now three, was born without complications. Encouraged by this and by testimonials from the group, Barbara later took kratom regularly during her third pregnancy, with her son who is now one. “I didn’t have any complications or problems,” she says.

    Curious if other mothers experienced the same, Barbara has been polling her group over the years, including about long-term development. “We’ve had about 150 people contribute to that poll,” she says. “And all of them say that their kids have either met their milestones or are ahead of their milestones.”

    That doesn’t mean there haven’t been complications, but Barbara notes that none have been life-threatening. “Nausea was probably the biggest thing … Women have complained about being more constipated.”

    “Most women do not tell their doctors about their kratom use when they’re pregnant because they are afraid of CPS,” Barbara continues. “But a couple have told their doctors and two of those cases did have CPS get involved. Of course it was a nightmare, because CPS is always a nightmare, but the case was always closed at the end fairly quickly.”

    For other mothers, kratom has played a determinant role in pregnancy.

    “If it wasn’t for kratom, I wouldn’t have had another baby because I was on so much medication,” says Jen, 39, a mother of four from northern Utah. Jen has suffered from chronic pain and PTSD since her teens. During her first three pregnancies, she took low-dose Percocet to handle the pain. “When I found kratom, it literally saved my life. I was on seven different prescriptions and over 60 pills a day. I could barely get off the couch and my life was wasting away … after two months of kratom, I was able to stop taking everything.”

    “I had no side effects while using and pregnant,” Jen says. She was taking about 18 to 20 grams of kratom per day. “My baby was perfectly healthy and beautiful. She is now 15 months and talking more like a three-year old, ahead of all milestones.”

    Eliza tells me that because she admitted to using kratom, she was held in observation at the hospital for five days.

    Eliza*, 38, is a mother of three from Kingston, New York. She has spinal stenosis and degenerative disc disease, and first learned about kratom through a chronic pain support group two years ago. Kratom helps her pain like nothing else, she says.

    “After learning that I was pregnant [a third time], I made a tremendously difficult decision to keep taking kratom rather than switch back to opiate pain medication, as my doctors recommended,” Eliza says in an email. “I was constantly stressed about unknown consequences, as there isn’t adequate research to-date on kratom in pregnancy, but I trusted my gut; it felt like the right way to proceed.”

    During Eliza’s second pregnancy, she was prescribed oxycodone, which brought her daughter to the NICU with opioid withdrawals for 12 days. But during her third pregnancy she took 30 grams of kratom tea per day, which she fully disclosed to her doctors. Her son, now seven months old, was born without complications and is ahead of all his milestones, according to Eliza.

    “My doctors were very skeptical of the decision that my husband and I made for me to continue taking kratom during pregnancy,” Eliza says. “During labor and while recovering from childbirth, in the first days with our son, many of my nurses had negative reactions to my kratom consumption. I declined their Percocet, but I hid in the bathroom to mix and drink my tea.”

    Eliza tells me that because she admitted to using kratom, she was held in observation at the hospital for five days. “I also didn’t feel comfortable telling anyone other than my husband, my doctors, and immediate family members that I was taking kratom during pregnancy for fear of disapproval or judgement,” she says. “I had a beautiful and uncomplicated vaginal birth, yet we declined visitors and told friends that I’d had a complicated C-section delivery to justify such a long postpartum hospital stay.”


    The Need for Perspective

    Anecdotes, of course, are not data, and none of this should be taken as advocating kratom use during pregnancy. But these stories do illustrate that there’s more to pregnant kratom use than dominant narratives suggest—and that more research in this area, which will become much harder to conduct if the DEA schedules kratom, would be welcome.

    There’s also the question of whether kratom use during pregnancy is really so widespread as some suggest.

    Joelle Puccio is a travel nurse currently based in Oakland who specializes in neonatal intensive care, working on the units where babies suffering withdrawals often wind up. In her cross-country travels, she says she has never encountered a pregnant person who says that they use kratom. She believes it’s pretty uncommon.

    “Of course, the misapprehension that it’s perfectly benign is a real problem, but if it were a newly discovered synthetic, everyone would be very excited about it,” says Puccio. “It’s as if the medical establishment is pouting because somebody else found it first. This hysteria is the direct result of capitalism and racism, like the rest of the drug war.”

    “It’s not surprising that people can get tolerance and dependence, but it really does seem like the infant effects are a lot milder than other drugs that we know about,” she continues. “The case [studies] where babies needed longer treatments more similar to what we currently see with heroin, methadone and buprenorphine, were all complicated by other factors and other medications. Only a couple cases described only kratom, and [in] those ones the babies were out of the hospital and done with their withdrawal in a week.”

    Kratom use may bring some risks, but if it becomes illegal, it may leave some mothers with fewer options, including prescriptions that may have greater risks.

    On the other hand, Marcela Smid, a maternal fetal medicine specialist and a high-risk obstetrician, believes kratom use during pregnancy is going undetected. In Utah, she manages a specialty prenatal clinic for pregnant and postpartum women with addiction. Smid co-authored one of the case studies published in October, detailing two mothers whose babies were exposed to kratom in the womb.

    One mother made the switch from kratom to buprenorphine and gave birth to a healthy girl with no withdrawals. The other reported smoking kratom (uncommon in the kratom-using community), switched to buprenorphine and continued using prescriptions for escitalopram, lamotrigine and quetiapine—respectively an antidepressant, an anticonvulsant and an antipsychotic. Her daughter was born healthy, but did suffer opioid withdrawals, which were treated with morphine.

    “In a year, I have seen three women with kratom,” Smid tells me on the phone. “It makes me think that the prevalence is probably much higher than we know about [because] we’re not asking about it, and it doesn’t come up on any drug screen.”

    Smid says that more doctors need to be aware their patients could be using kratom. According to her, kratom is quite familiar in the addiction treatment world, but in the obstetric world it’s almost completely unknown.

    “I do not recommend kratom use in pregnancy and postpartum as we simply do not understand enough about the herb to know what the risks and benefits are,” Smid says. “If someone is using kratom to self-treat an opioid addiction, I encourage them to seek care with an OB knowledgeable in perinatal addiction or an addiction specialist. The risk of relapse with untreated addiction is high, especially postpartum when the risk of relapse, overdose and death is highest.”

    “Seeking treatment for addiction while pregnant can be a scary notion for many women,” Smid adds. “Getting treatment is the best things moms can do for themselves and for their babies.”

    “I really don’t want to do that and it just makes me want to cry.”

    If, as Smid says, the prevalence of kratom use during pregnancy is high, it would suggest that the prevalence of reported associated problems is relatively low. And while no one would argue against the availability of addiction treatment for those who seek it, such programs are often scattered or expensive, making access to drugs like buprenorphine more about privilege than desire. Which gets us to the root of the issue: why pregnant people are using kratom in the first place.

    “If she’s using kratom instead of heroin, I would consider that to be harm reduction,” Puccio says. “If she was using it [instead of] cannabis, that I maybe would not consider to be harm reduction. It just would depend on the context.”

    “Pregnant people take drugs for the same reasons that anybody takes drugs,” Puccio adds. “Even in the case studies, a lot of people were taking it to get off other opioids. There was the one gal that had the chronic back pain and fibromyalgia, there was one lady that had uncontrolled anxiety and depression. These are the reasons that people take any drug and a lot of these conditions tend to be exacerbated by pregnancy, especially lower back pain, anxiety and depression.”

    In other words, kratom use may bring some risks, but if it becomes illegal, it may leave some mothers with fewer options, including prescriptions that may have greater risks. “I see [kratom] as something that could really help babies, to be honest, just because of what the alternatives are,” Barbara says.

    If kratom is banned, Barbara hopes that she and other moms in her kratom group are given enough time to wean off it slowly. “Especially the moms that are pregnant, that’ll be important,” she says. “And then, I don’t know, I’d just have to go on my track of trying one medication after the other again, which is a complete nightmare, and I really don’t want to do that and it just makes me want to cry.”

    *Names have been changed.

    • Troy is an independent journalist whose reporting on drug policy and science has appeared in Wired, the Guardian, Undark, Discover Magazine, Vice and more. He co-hosts the drug policy podcast Narcotica. He lives in Southwest California.

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