Prescription Opioid Epidemic and Infant Outcomes

Abstract

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.

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

“…However, this body of literature demonstrates tremendous variability; infants treated with morphine may be treated as long as 37 days or as short as 12 days. 9,[23][24][25] This variation supports the theory that the environment of care is likely more important than the medication used for treatment. Two recent multicenter Ohio collaborative reports and a single-center study in NICUs showed a decreased LOS to between 18 and 23 days with use of a standardized weaning protocol.…”

“…The physician group delayed initiating pharmacotherapy in the first 24 to 36 hours when exposure to long-acting opioids together with tobacco or selective serotonin reuptake inhibitors exacerbated early withdrawal symptoms; these exposures co-occur frequently. 23 …”

“…There is a higher likelihood of pharmacologic therapy for NAS in infants exposed to tobacco and antidepressants. 23 Most previous NAS QI reports have not aimed to reduce the proportion of pharmacologically treated infants. We achieved a 41% relative reduction in the proportion of opioid-exposed infants treated with medications.…”

Families Affected by Parental Substance Use

“…11 This problem persists, as evidenced by a recent study that showed among 112 029 pregnant women, 31 354 (28.0%) were prescribed at least 1 opioid pain reliever during pregnancy. 12 It is estimated that 1 in 5 children grows up in a home in which someone uses drugs or misuses alcohol. 7 The exact number of children living with adults with SUDs is unknown 13 ; however, an estimated 8.3 million children younger than 18 years (12%) were residing with at least 1 substance-dependent or substance-using parent between 2002 and 2007.…”

A Public Health Response to Opioid Use in Pregnancy

“…1 Although concern regarding substance use in pregnancy is not new, it has recently increased among health care providers, the public, and policy makers as the opioid epidemic's impact reached an increasing portion of the US population, including pregnant women and their infants. 2,3 Several recent studies highlighted an increase in prescription opioid use among women of childbearing age 4 and among pregnant women. 5,6 As opioid use among pregnant women increased, the rate of infants in the United States experiencing opioid withdrawal after birth, known as neonatal abstinence syndrome (NAS), grew nearly fivefold over the past decade.…”