Opioids and Prescription Drugs
QUICK FACTS:
Types of opioids:
Natural opiates such as Morphine, Heroin, and Codeine
Synthetics commonly known as the pain pills Oxycodone, Hydrocodone, and Hydromorphone
Opioid use in pregnancy has become a public health crisis.
Maternal Opioid-related Diagnosis (MOD) in hospital deliveries more than doubled between 2010 and 2017 (clean up indentation after bulletpoints on website) (increased from 3.5 to 8.2 per 1000 deliveries)1
Individuals who use opioids typically have other coexisting problems (medical, psychological, financial, social) that make it difficult to distinguish the direct effect of opioids on pregnancy and birth related complications.
POSSIBLE RISKS:
Increased risk of obstetric complications including2-4:
Intrauterine growth restriction (slow growth during pregnancy)
Placental abruption (placenta separation from uterus)
Preterm Labor
Miscarriage or Stillbirth
*It is difficult to determine how much risk is associated with Opioid use versus other coexisting medical problems and substances
Neonatal Abstinence Syndrome (NAS):
NAS is withdrawal from any substance in an infant that was exposed during pregnancy.
Most commonly due to Opioids
Symptoms include5,6:
Fragmented sleep cycle
Difficulty staying alert
Hypertonicity (stiffness) or jitteriness
Autonomic dysfunction (sweating, sneezing, fever, nasal stuffiness, frequent yawning)
Sensitivity, irritability, and crying with any stimuli
Difficulty feeding/swallowing
Withdrawals can occur as early as within the first 24 hours and almost always occur within the first week5-8.
Infants will be observed for 3-7 days if NAS is suspected.
NAS is NOT associated with death
WHAT TO LOOK FOR:
Watch for the above symptoms within the first week of life.
Keep in mind that any time illegal substances are used, other substances are much more likely to be used concurrently.
WHAT TO DO:
NAS is almost always going to occur at the hospital under the care of the medical team, so you will likely not need to do anything besides be there for your baby.
The long-term effects of opioid use in pregnancy are not well understood, so there is no action that you need to take to help your child long term.
If you have any concerns, talk to your pediatrician.
- Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA. 2021 Jan 12;325(2):146-155. doi: 10.1001/jama.2020.24991. PMID: 33433576; PMCID: PMC7804920.
- Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014 Dec;121(6):1158-65. doi: 10.1097/ALN.0000000000000472. PMID: 25405293.
- Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy. Effects and management. Obstet Gynecol Clin North Am. 1998 Mar;25(1):139-51. doi: 10.1016/s0889-8545(05)70362-4. PMID: 9547764.
- Azuine RE, Ji Y, Chang HY, Kim Y, Ji H, DiBari J, Hong X, Wang G, Singh GK, Pearson C, Zuckerman B, Surkan PJ, Wang X. Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population. JAMA Netw Open. 2019 Jun 5;2(6):e196405. doi: 10.1001/jamanetworkopen.2019.6405. PMID: 31251378; PMCID: PMC6604084.
- Patrick SW, Barfield WD, Poindexter BB; COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020 Nov;146(5):e2020029074. doi: 10.1542/peds.2020-029074. PMID: 33106341.
- Velez M, Jansson LM. The Opioid dependent mother and newborn dyad: non-pharmacologic care. J Addict Med. 2008 Sep;2(3):113-20. doi: 10.1097/ADM.0b013e31817e6105. PMID: 19727440; PMCID: PMC2729936.
- Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014 Aug;134(2):e547-61. doi: 10.1542/peds.2013-3524. PMID: 25070299.
- Zelson C, Rubio E, Wasserman E. Neonatal narcotic addiction: 10 year observation. Pediatrics. 1971 Aug;48(2):178-89. PMID: 5560613.