Chronic Opiate Use in Pregnancy and Newborn Head Circumference

Visconti, Kevin; Hennessy, Kerry; Towers, Craig V.; Howard, Bobby

doi:10.1055/s-0034-1374817

Cited by 21 publications

(17 citation statements)

References 15 publications

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“…Our findings were similar to the retrospective material previously reported from our institution that had stimulated the current, more-rigorous, and prospective investigation. 6 In that previous study, 332 neonates treated for NAS were compared with controls, and greater proportions of infants with NAS had a newborn HC less than or equal to the 10th and less than or equal to the third percentiles. In that study, authors were unable to make a definitive conclusion about the possible effect of antenatal opioid exposure on neonatal HC because data pertaining to other possible confounding drugs and exposures were incomplete.…”

Section: Discussionmentioning

confidence: 97%

“…The primary planned study end point was a comparison of neonatal HC between the cases and controls. Using data from the previous published retrospective study from the same institution, 6 we determined that 754 study participants (377 in each group) were needed to detect a minimum increase in the percentage of neonates with an HC less than the 10th percentile from 10% in controls to 20% in infants with NAS by using an α (type I error) of .01 with 90% power. On the basis of the average number of NAS cases managed at our institution each month before study initiation, we anticipated that this investigation would span a minimum of 30 months.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous retrospective study from our institution, researchers did find an association of smaller HCs in newborns treated for NAS compared with controls; but, because of the retrospective nature of the investigation, accurate information in which authors detailed the type of maternal opioid and other coexposures and provided better pregnancy dating were lacking. 6 We report results of a prospective study we designed to determine if chronic opioid use during pregnancy, sufficient enough for the neonate to require treatment for signs of NAS, is associated with smaller HCs compared with newborns who are not exposed to opioids.…”

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confidence: 99%

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Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

et al. 2018

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OBJECTIVES:To compare head circumference (HC) in neonates treated for neonatal abstinence syndrome (NAS) with control neonates without antenatal opioid exposure. METHODS:Our prospective cohort study ran from April 1, 2014, through December 31, 2016. Newborns treated for NAS delivered from well-dated pregnancies ≥34 weeks' gestation were compared with newborns who were nonopioid exposed and matched for race, parity, mode of delivery, and gestational age. All mothers underwent serial antenatal urine drug testing. A minimum of 754 study participants were needed (377 in each group) to demonstrate an increase in the proportion of newborns with HCs less than or equal to the 10th percentile from 10% in controls to a minimum of 20% in NAS newborns with 90% power. RESULTS:A total of 858 neonates were enrolled (429 NAS cases and 429 controls). Mean HC for cases was 33.04 cm (±1.9 cm) compared with 33.99 cm (±2.0 cm) for controls (P < .0001). Among the 429 NAS cases, the mothers of 372 (87%) were on opioid medicationassisted treatment. For NAS cases, 30.1% (95% confidence interval: 25.8%-34.7%) had an HC less than or equal to the 10th percentile (129 of 429 neonates), and 8.2% (95% confidence interval: 5.8%-11.2%) had an HC less than or equal to the third percentile (35 of 429 neonates). Multivariate analysis was used and determined that only chronic opioid use during gestation resulting in a neonate who was NAS treated was a significant risk factor for the observed smaller HC. CONCLUSIONS: Chronic opioid use during pregnancy sufficient to cause NAS was associated with smaller HCs at birth. Most mothers were on opioid agonist medication-assisted treatment, which is currently the recommended treatment option during pregnancy.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

et al. 2018

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“…Not only does NAS result in significant distress to the neonate, but there is also a growing body of evidence that this might lead to longterm consequences. For example, some studies have found smaller newborn head circumferences, 61,62 smaller brain volumes in childhood, [63][64][65] and behavioral and cognitive issues in children who experienced NAS. [66][67][68] Despite these reports, further studies on long-term maternal outcomes both during the pregnancy and after delivery, as well as long-term follow-up of the newborns that experience tapering/detoxification during gestation, are needed.…”

Section: Discussionmentioning

confidence: 99%

Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review

et al. 2019

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Objective This study aimed to perform a systematic review of all studies reporting fetal outcomes following detoxification or tapering of opioid drugs during pregnancy. Study Design PubMed, Scopus, Medline, and Google Scholar were searched, and only manuscripts clearly reporting pregnancy/fetal outcomes involving tapering or detoxification from opioid drugs were included. Only pregnancies managed after 1980 were included (when antenatal fetal surveillance became more routine). Collected data included study design, location, years patients were managed, number of patients who were tapered or detoxified, method of tapering, and pregnancy outcome. Results A total of 14 publications met the criteria for review after evaluating more than 2,000 abstracts and 153 published manuscripts. In 1,097 pregnancies, based on mortality rate analyses and forest plots, no increased fetal risks due to tapering or detoxification from opioid drugs were identified. No increased risk of preterm delivery was found. Conclusion Pregnant women with opioid use disorder who are stable in a medication-assisted treatment program with behavioral health can be informed that tapering or full detoxification from opioid drugs does not increase the fetal risk of poor pregnancy outcome. Future research needs to answer the questions on maternal and long-term newborn consequences of tapering or detoxification versus long-term newborn consequences of continued chronic in utero opioid exposure.

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“…A prospective study on this subject will be finished within the next year to see whether it corroborates the findings of the retrospective analysis. 3 Concern about possible rare adverse outcomes is theoretic and unproven. The authors of the letter seem to discount the suffering that neonates experience when they are born with neonatal abstinence syndrome.…”

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confidence: 99%

Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial

Ahn

Lee

Kwon

2017

American Journal of Obstetrics and Gynecology

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A 0 and A 0 ', outer edge of incised myometrium; A 1 , point of needle entry; A 1 ', point of needle exit; B 0 and B 0 ', inner edge of incised myometrium; D 0 and D 0 ', each edge of incised decidua; D 1 , the point of needle exit; D 1 ', the point of needle entry; X and X', the end point of coaptated myometrium from B 0 and B 0 '.Ahn. Impact of uterine closure on RMT after cesarean. Am J Obstet Gynecol 2017.

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Chronic Opiate Use in Pregnancy and Newborn Head Circumference

Abstract: Chronic opiate use in pregnancy appears to increase the risk for a HC ≤ 10th percentile and ≤ 3rd percentile when compared with controls. From ultrasound findings, femur and humerus lengths also appear to be shortened suggesting a possible effect on bone growth.

Cited by 21 publications

References 15 publications

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review

Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial

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