In the Journals

Prescription opioid use in pregnancy linked with neonatal abstinence syndrome

Prescription opioid pain reliever use before and during pregnancy was significantly associated with development of neonatal abstinence syndrome, according to study findings.

In addition, researchers found that prenatal prescription opioid exposure, opioid type, tobacco use and selective serotonin reuptake inhibitor use also increased the risk for neonatal abstinence syndrome.

“Historically, drug withdrawal for newborns has been described among illicit drug use such as heroin or women treated for previous opioid abuse, but this is really one of the first studies to look at legal prescriptions for pregnant women. And it draws attention to what is going on in our nation,” Stephen W. Patrick, MD, MPH, from the division of neonatology at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, said in a press release.

Stephen W. Patrick

To identify neonatal complications associated with antenatal opioid pain reliever exposure and determine predictors of neonatal abstinence syndrome, Patrick and colleagues used prescription data linked to vital statistics for mothers (n = 112,029) and infants enrolled in the Tennessee Medicaid program between 2009 and 2011.

Researchers evaluated the relationship between prenatal opioid exposure with neonatal abstinence syndrome via multivariable logistic regression, controlling for maternal and infant characteristics.

Twenty-eight percent of the cohort filled at least one opioid prescription. Women prescribed opioid pain relievers were found to be more likely than those not prescribed opioids (P < .001) to smoke tobacco (41.8% vs 25.8%) and to exhibit depression (5.3% vs. 2.7%) and anxiety disorder (4.3% vs. 1.6%).

“We found that babies exposed to opioid pain relievers were more likely to be born preterm, have complicated births, low birth weight and have complications such as meconium aspiration syndrome and respiratory distress,” Patrick said in the release.

In a multivariable model, researchers observed that higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of cigarettes smoked daily (P < .001), and selective serotonin reuptake inhibitor use (OR = 2.08; 95% CI, 1.67–2.6) were linked to higher risk for neonatal abstinence syndrome.

“Public health efforts should focus on limiting inappropriate opioid pain relievers and tobacco use in pregnancy,” Patrick and colleagues wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”

Disclosure: The researchers report no relevant financial disclosures.

Prescription opioid pain reliever use before and during pregnancy was significantly associated with development of neonatal abstinence syndrome, according to study findings.

In addition, researchers found that prenatal prescription opioid exposure, opioid type, tobacco use and selective serotonin reuptake inhibitor use also increased the risk for neonatal abstinence syndrome.

“Historically, drug withdrawal for newborns has been described among illicit drug use such as heroin or women treated for previous opioid abuse, but this is really one of the first studies to look at legal prescriptions for pregnant women. And it draws attention to what is going on in our nation,” Stephen W. Patrick, MD, MPH, from the division of neonatology at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, said in a press release.

Stephen W. Patrick

To identify neonatal complications associated with antenatal opioid pain reliever exposure and determine predictors of neonatal abstinence syndrome, Patrick and colleagues used prescription data linked to vital statistics for mothers (n = 112,029) and infants enrolled in the Tennessee Medicaid program between 2009 and 2011.

Researchers evaluated the relationship between prenatal opioid exposure with neonatal abstinence syndrome via multivariable logistic regression, controlling for maternal and infant characteristics.

Twenty-eight percent of the cohort filled at least one opioid prescription. Women prescribed opioid pain relievers were found to be more likely than those not prescribed opioids (P < .001) to smoke tobacco (41.8% vs 25.8%) and to exhibit depression (5.3% vs. 2.7%) and anxiety disorder (4.3% vs. 1.6%).

“We found that babies exposed to opioid pain relievers were more likely to be born preterm, have complicated births, low birth weight and have complications such as meconium aspiration syndrome and respiratory distress,” Patrick said in the release.

In a multivariable model, researchers observed that higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of cigarettes smoked daily (P < .001), and selective serotonin reuptake inhibitor use (OR = 2.08; 95% CI, 1.67–2.6) were linked to higher risk for neonatal abstinence syndrome.

“Public health efforts should focus on limiting inappropriate opioid pain relievers and tobacco use in pregnancy,” Patrick and colleagues wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”

Disclosure: The researchers report no relevant financial disclosures.