Babies whose mothers underwent surgery before pregnancy have an increased risk of opioid withdrawal symptoms at birth, according to a study published in CMAJ.
“Use of opioids for pain control after surgery may increase the risk of opioid dependence in women and withdrawal in their newborns,” said Nathalie Auger, MD, University of Montreal Hospital Research Centre, Montreal, Quebec.
“We found that mothers who had surgery before pregnancy had 1.6 times the risk of neonatal abstinence syndrome, perhaps because opioid use continue[d] after surgery.”
For the study, Dr. Auger and colleagues included data on 2,182,365 births in Quebec between 1989 and 2016. Of these, 2,346 newborns had neonatal abstinence syndrome, including 1,052 who had mothers who underwent pre-pregnancy surgery compared with 1,294 babies born to mothers who did not have surgery.
Multiple surgeries; younger age at surgery; longer time between surgery and pregnancy; and cardiovascular, thoracic, urologic, or neurosurgery were associated with the largest risk of neonatal abstinence syndrome. There was also a strong association with general anaesthesia, perhaps because this type of anaesthesia is used in more complex surgeries, which can require longer use and higher dosage of pain relievers.
“Physicians have the potential to prevent neonatal abstinence syndrome with careful postoperative pain management in young women,” noted Dr. Auger. “Opioids continue to be overprescribed, despite calls to optimise postsurgical pain control through improvement of surgical guidelines and use of multipronged approaches with non-opioid painkillers or local anaesthetics.”
“Limiting postoperative opioid exposure, reducing overprescribing, and screening for opioid use in pregnant women who have had previous surgery may help reduce the risk of neonatal abstinence syndrome,” she concluded.