A growing number of pregnant women turn to opioids to relieve their pain, but possible abuse of the drugs threaten their safety and that of their babies.
Opioid use in pregnancy has risen dramatically in recent years, coinciding with other problems nationally involving opioids.
The number of delivering mothers using or depending on opioids rose nearly five-fold over a decade-long stretch. And from 1992 to 2012, the proportion of pregnant women admitted for substance abuse treatment reported a history of prescription opioid abuse increase from 2 percent to 28 percent.
Adverse Neonatal Outcomes
The rising use of opioids in pregnancies has led to what has been termed adverse neonatal outcomes, including neonatal abstinence syndrome (NAS). NAS is a drug withdrawal syndrome that these infants exposed to opioids experience shortly after birth. There are a host of conditions that could impact the babies, such as withdrawal symptoms, seizures, fever and poor feeding. In addition, studies show that newborns with NAS were more likely than other babies to have low birth weight and respiratory issues. In addition, the children may face learning disabilities.
Among the strong prescription painkillers are oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. They are generally safe when taken for a short time as prescribed but dependence and overdoses are considered major risks.
Neonatal Abstinence Syndrome
The NAS may result from chronic opioid use during pregnancy, and although it is a treatable condition, officials are warning about the risks. Other opioid issues may result for the newborn, including defects of the brain, spine or spinal cord, congenital heart defects, and other areas, including miscarriage and stillbirth, preterm birth.
Although many conditions can be resolved, some unknown outlooks are uncertain, depending on the condition. Exposure to methadone, buprenorphine, nicotine and other drugs also can increase the incidence of neonatal abstinence syndrome.
Advice Regarding Opioid Use
If a pregnant woman has to take an opioid medication, she should consider these conditions for safety.
· Only take them for a short period
· Take the lowest possible dose
· Always follow medical instructions
· Reach out for help if you have side effects
Providers are advised to routinely screen all pregnant women for substance use, and should be done on the first visit. If screening is focused on only certain issues, such as adherence to prenatal care, there can be missed cases.
“To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations,” according to the American College of Obstetricians and Gynecologists.
In 2012, the American Academy of Pediatrics released a policy statement calling for “standardizing care for substance-exposed infants at risk of NAS.” Since then, experts say following treatment protocols is linked to improved outcomes.
The ACOG and other medical groups are working to coordinate their professional guidelines regarding prenatal substance use to improve policy on the issue.
National Institute on Drug Abuse. 2018. Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome Retrieved from: //www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome
The American College of Obstetricians and Gynecologists. Women’s HealthCare. ACOG Committee. 2017. No. 711. 2018. Retrieved from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy?IsMobileSet=false
Krans, E, MD, MSc, Patrick, S, MD, MPH, MSC et al. Opioid Use Disorder in Pregnancy Health Policy and Practice in the Midst of an Epidemic. Obstetrics and Gynecology. 2016. July 128 (1): 4-10. Doi: 10.1097/AOG.0000000001446
U.S. National Library of Medicine. MedlinePlus. 2018. Pregnancy and Opioids. Retrieved from: https://medlineplus.gov/pregnancyandopioids.html
Lindsay Tanner, Associated Press. Mothers’ Prenatal opioid use may stunt children’s learning. Retrieved from Chicago Tribune: https://www.npr.org/sections/health-shots/2018/05/08/605358266/for-babies-of-the-opioid-crisis-best-care-may-be-moms-recovery