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Prescription opioid abuse in pregnancy puts babies at risk
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Prescription opioid abuse in pregnancy

Prescription painkillers, known as narcotics or opioids, have been on the rise for many years, but their rise in one population is much more troublesome than others — the pregnant population. Clinicians have seen a rise in opioid use among pregnant women in the U.S., and this is not only harmful to the female patients themselves but also to their unborn babies. Opioid medications are used to treat severe pain, and that pain relief does come at a high cost. Addiction, withdrawal and overdose are common occurrences with these prescription painkillers.

Astonishing statistics

Every 25 minutes a baby is born suffering from opioid withdrawal. Thirty-nine percent of pregnant women who have Medicaid between the ages of 15 and 44 filled opioid prescriptions from 2008 to 2012, and 28 percent of all pregnant women with private insurance within the same age range filled opioid prescriptions from 2008 to 2012.

Roughly 2 to 3 percent of mothers reported that they were treated with opioid analgesics just before or during early pregnancy. Codeine and hydrocodone were most often reported and represented 69 percent of the opioid analgesics used, according to the Centers for Disease Control and Prevention and other reports. Of course, illegal forms of opioids such as heroin are also on the rise.

Birth defects caused by opioid abuse

Although mothers are affected by opioid abuse, their unborn babies seem to take the hardest hit. Congenital heart disease is prevalent and affects approximately 1 percent of U.S. births, and is a leading cause of mortality in infants who have a congenital defect. Opioids, when used in the first trimester, are known to cause a multitude of birth defects including congenital hearts defects such as atrial septal defect, atrioventricular septal defect, hypoplastic left heart syndrome and Tetralogy of Fallot. Other birth defects directly related to opioid use in the first trimester are as follows:

  • Glaucoma — an increase in intraocular pressure resulting in damage to the optic nerve, eventually leading to blindness
  • Spina bifida — an opening in the neural tube that, depending on the severity, can cause deficits in motor skills
  • Hydrocephalus — fluid on the brain that causes headache and head enlargement
  • Gastroschisis — an opening in the abdominal wall resulting in exposure to the abdominal organs to the outside environment

These congenital diseases are disabling and can be life threatening. As mentioned before, these congenital defects result when opioids are used in the first trimester, as most of the vital organs undergo development during this period. Severe consequences also occur when expecting mothers consume narcotics later on in the pregnancy. Neonatal withdrawal syndrome occurs when the unborn baby becomes addicted to opioids while in utero and after birth shows signs of opioid withdrawal.

Delivery complications

The placenta is a conduit between the mother and baby and everything the expecting mother consumes goes right into her baby via the placenta. If mom shoots up heroin while pregnant, her baby will also be stoned from heroin as well. Once the baby is born, he or she is not connected to the placenta and is, therefore, depleted of opioids. As a result, the infant will show signs of withdrawal within the first 24 hours. These include poor feeding, lethargy and even seizures. Treatment often consists of giving opioids to the newborn to slowly wean the baby from the addiction.

Preterm birth and placental abruption — in which the placenta becomes unattached from the uterus and results in painful hemorrhage — are also two other common manifestations that can result from the use of intrapartum opioid use, not to mention the potential long-term learning deficits the child is at risk for.

Preventive steps

To prevent these terrible effects from happening, it is important that clinicians have an honest conversation with their patients about their past and current medication history. Additionally, prescribing non-narcotics should always be the first step for chronic pain, and weaning narcotics during pregnancy should be an active process between the physician and the pregnant patient. With one step at a time, hopefully this growing epidemic can be managed.

Sovereign Health of Arizona is a women’s treatment center that specializes in providing therapy for trauma and abuse, addiction, mental health disorders and dual diagnosis. Our substance abuse treatment program offers care for prescription drug abuse as well as numerous other addictions. For more information, please call our 24/7 helpline.

About the author

Kristen Fuller, M.D., is a senior staff writer at the Sovereign Health Group and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at news@sovhealth.com.

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