Neonatal abstinence syndrome (NAS) has historically been associated with illicit drug use among pregnant women. However, a study published in the April issue of the journal Pediatrics showed an increased likelihood of NAS among pregnant women were narcotic pain relievers such as hydrocodone.
In addition, the study found that opioid type and duration of exposure combined with tobacco use or selective serotonin reuptake inhibitor use augmented risks for NAS.
The study looked at 3 years of data from TennCare — Tennessee’s Medicaid program — and assessed records for 112,029 pregnant women. An estimated 28% of the women, or 31,354, were prescribed and filled at least 1 opioid pain reliever. Of the babies with NAS, 65% had mothers that legally filled prescriptions for opioid pain relievers.
“We found that babies exposed to opioids pain relievers were more likely to be born preterm, have complicated births, low birth weight, and have complications such as meconium aspiration syndrome and respiratory distress,” said lead author Stephen Patrick, MD, Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee.
“Not all babies exposed to opioids have drug withdrawal after birth for reasons that aren’t entirely clear,” he added. “Our study found that several things increased an infant’s risk, including the duration of opioid use, the type of prescription opioid, how many cigarettes a woman smoked, and if they used selective serotonin reuptake inhibitors.”
The study showed that compared with women with no opioid exposure, the pregnant women who took opioid pain relievers were more likely to be white, have anxiety or depression, suffer from headache or migraine, and have musculoskeletal disease. A majority of the women prescribed opioids (96%) were prescribed short-acting medications, while 2% received maintenance doses and <1% received long-acting opioids.
“Historically, drug withdrawal for newborns has been described among illicit drug use such as heroin or women treated for previous opioid abuse, but this is really one of the first studies to look at legal prescriptions for pregnant women, and it draws attention to what is going on in our nation,” said Dr. Patrick.