Increasing pregnancy-related use of prescribed opioid analgesics

Epstein, Richard A.; Bobo, William V.; Martin, Peter; Morrow, James; Wang, Wei; Chandrasekhar, Rameela; Cooper, William O.

doi:10.1016/j.annepidem.2013.05.017

Cited by 116 publications

(98 citation statements)

References 60 publications

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“…Similar to previous smaller studies, we found that dose of maintenance opioids did not modify the risk of NAS. 8,9 Furthermore, our findings provide important information that builds on previous studies of OPR use in pregnancy 3,35,36 and several publications describing tobacco and SSRI use in the context of opioid maintenance. [10][11][12] Both tobacco and SSRIs have been described in the literature as having individual withdrawal syndromes and unique toxidromes.…”

Section: Figuresupporting

confidence: 70%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

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272

195

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BACKGROUND AND OBJECTIVES: Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS). METHODS:We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.RESULTS: Of 112 029 pregnant women, 31 354 (28%) filled $1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P , .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P , .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P , .001), opioid type (P , .001), number of daily cigarettes smoked (P , .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.CONCLUSIONS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS. WHAT'S KNOWN ON THIS SUBJECT:Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is not well described. Further, factors associated with development of neonatal abstinence syndrome, a neonatal opioid withdrawal syndrome is inadequately understood.WHAT THIS STUDY ADDS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of neonatal abstinence syndrome.

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Section: Figuresupporting

confidence: 70%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

Self Cite

272

195

View full text Add to dashboard Cite

show abstract

“…[52][53][54][55] A recent study reported that 6% of mothers used opioids for more than a month during pregnancy. 56 Another study reported that the incidence of oxycodone abuse among pregnant women doubled within the 18-month study period.…”

Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…1 Over the last decade, the number of infants with NAS grew nearly 5-fold, in parallel with an increase in opioid use in pregnancy. [2][3][4][5][6] Although the number of infants with NAS grew, several studies reported variable approaches to diagnosis and treatment of the syndrome. 7,8 In response to the growth and variable treatment of these infants with NAS, the American Academy of Pediatrics (AAP) released a policy statement in 2012 calling for standardization of care delivered to infants with the syndrome.…”

mentioning

confidence: 99%