Increase Awareness of the Risks of Opioid Use & NAS for Mothers with SUDs

Return toExpand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use
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Background 

Overview

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as her potential treatment options for opioid use disorder.

Opioid Use During Pregnancy

Opioid use in women aged 15–44 years has increased over time. This increase is similar to the dramatic increase in overall use in the United States. During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. As such, opioid use during pregnancy is not uncommon. There have been significant increases in opioid use disorder during pregnancy. For example, the number of women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014.

 

Opioid exposure during pregnancy has been linked to some negative health effects for both mothers and their babies. These include maternal death and poor fetal growth, preterm birth, stillbirth, possible specific birth defects, and neonatal abstinence syndrome. The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and outweigh the risks of these potential negative health outcomes.

 

Neonatal Abstinence Syndrome (NAS)

Overview

Opioid use and medication assisted treatment for opioid use disorder during pregnancy can lead to neonatal abstinence syndrome (NAS) in some newborns. NAS is a group of conditions that can occur when newborns withdraw from certain substances including opioids that they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include:

• Tremors (trembling)
• Irritability, including excessive or high-pitched crying
• Sleep problems
• Hyperactive reflexes
• Seizures
• Yawning, stuffy nose, or sneezing
• Poor feeding and sucking
• Vomiting
• Loose stools and dehydration
• Increased sweating

The symptoms a newborn might experience, and how severe the symptoms will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to more than one substance before birth.

Birth Outcomes Associated with Opioid Use During Pregnancy

Infants exposed to opioids during pregnancy might be more likely to

• Be born preterm (born before 37 weeks of pregnancy);
• Have poor fetal growth;
• Have longer hospital stays after birth;
• Be re-hospitalized within 30 days of being born; and
• Possibly be born with birth defects.

Longer-Term Developmental Outcomes

There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes not obvious at birth. Results from a recent studyexternal icon suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findingsexternal icon about long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

 

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Sources

https://www.cdc.gov/pregnancy/opioids/basics.html