Millions of American women use prescription opioid painkillers during pregnancy. Such use puts their babies at risk for neonatal abstinence syndrome (NAS) These babies are more likely to be born prematurely, have complicated deliveries, low birth weight and the risk of meconium aspiration and respiratory difficulties. They may also suffer from seizures, dehydration, tremors, difficulty feeding and irritability.
A study, conducted by researchers from Vanderbilt University Medical Center in Nashville, Tennessee and published in the journal Pediatrics showed that opioid pain relievers such as hydrocodone are commonly being prescribed to pregnant women, resulting in an increased risk of NAS. The researchers studied three years of data from Tennessee’s Medicaid program and the patient records of 112,029 pregnant women. It was found that approximately 28 percent of those women had received at least one prescription for an opioid pain reliever. Of the babies that were born with NAS, 65 percent had mothers who had received legal prescriptions for opioid pain relievers.
A comparison was made with mothers who did not receive opioids during pregnancy and found that the mothers who had used opioids were more likely to be white, suffer from anxiety or depression and have headaches or migraine and musculoskeletal disease. Short-acting medications were prescribed to 96 percent of the women, two percent were prescribed maintenance amounts and less than one percent was prescribed long-acting opioids.
Lead study author, Dr. Stephen Patrick, assistant professor of Pediatrics and Health Policy in the Division of Neonatology with the Monroe Carell Jr. Children’s Hospital at Vanderbilt said, “Not all babies exposed to opioids have drug withdrawal after birth for reasons that aren’t entirely clear. Our study found that several things increased an infant’s risk, including the duration of opioid use, the type of prescription opioid, how many cigarettes a woman smoked and if they used a common antidepressant medicine called selective serotonin reuptake inhibitors.”
Patrick noted that his study is one of the first to investigate the link between NAS and legal opioid prescriptions for pregnant women. Most prior research had focused on heroin use or previous opioid abuse among pregnant women.
The researchers explained the significant financial effect. For each dollar spent on short-acting opioid pain relievers, $50 is spent on care for babies suffering from drug withdrawal symptoms. The annual cost for treating babies with NAS is estimated to be $270 million. “All in all, we hope the study garners the attention of state and federal policy makers to highlight that the prescription opioid epidemic is having a tangible impact on both mothers and infants,” said Patrick.
Many women use opioid painkillers before they realize that they are pregnant, endangering their unborn babies. An analysis by the Centers for Disease Control and Prevention (CDC) of women between the ages of 15 and 44 discovered that a third of young women using Medicaid and a quarter of young women with private insurance had filled opioid prescriptions every year from 2008 through 2012. Doctors are concerned due to the fact that approximately 50 percent of U.S. pregnancies are unplanned and use of opioids such as oxycodone during the earliest weeks of pregnancy can cause birth defects.
CDC director, Dr. Tom Frieden said, “Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child.” Doctors working in obstetrics and neonatology agree that many of their patients have used prescription painkillers such as Vicodin and Percocet after becoming pregnant and some women are unable to stop.
Dr. Neil Seligman, assistant professor of obstetrics and gynecology at the University of Rochester Medical Center in Upstate New York said, “I do see opioid use pretty frequently in my high-risk practice but patients often don’t have their first prenatal care appointment until the late first trimester or early second trimester, at which point the fetus is no longer susceptible to birth defects.”
Birth defects occur when certain medications such as opioids are taken between the fourth and 10th weeks. Following that, discussions between doctors and pregnant women on opioids usually involve the dangers of neonatal withdrawal symptoms. The incidence of withdrawal is poorly understood by moms who are chronic, prescription opioid users. However, for heroin use, 60 to 70 percent of newborns require treatment for at least a month and, when properly managed, there are no long-term consequences.
Seligman said, “Receiving a one-time prescription for acute pain is of little concern especially after the first trimester. All physicians should be cognizant of the reproductive risks when prescribing medications to women of childbearing age. For women who are planning to become pregnant and require ongoing treatment with opioids, the best time to discuss the risks is during a preconception consultation with a physician who specializes in maternal-fetal medicine.”
Prior research has shown that opioid use during pregnancy may also increase the risk of major defects of the baby’s brain, spine and heart and cause a malformation of the baby’s abdominal wall called gastroschisis in which the abdominal contents protrude to the exterior abdomen.
Every brand new baby deserves the best possible start in life and the more people can be made aware of the consequences of opioid use, particularly in early pregnancy, the better prepared they can be for protecting their children.
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Written by Veronica McNamara, Sovereign Health Group writer
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