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Warning over growing opioid prescribing in pregnant women

Trend may be cause of rise in neonatal abstinence syndrome

Adrian O'Dowd

Wednesday, 13 January 2016

A drug misuse expert has warned about the growing trend of doctors prescribing opioids to pregnant women, in an editorial* published today in The BMJ.

In the US, it is estimated that 14-22% of pregnant women receive an opioid prescription during their pregnancy and there has been an increase in the prevalence of opioid use disorders among pregnant women.

At the same time, the incidence of neonatal abstinence syndrome (NAS), also known as neonatal withdrawal syndrome – increased from 1.20 to 3.39 per 1,000 live births between 2000 and 2009.

NAS is a serious medical condition that results from a newborn who was exposed to addictive illegal or prescription drugs while in the mother's womb.

The potential effects of opioid exposure on the foetal brain are unknown, but studies in rodents have linked it to birth defects in the central nervous system.

In addition, human epidemiological studies have found an association between opioid use during pregnancy and neural tube defects and other birth defects.

Other studies have suggested that opioid exposure could disrupt attachment between mother and baby, and cognitive impairments have been reported in children and young people born to women who misused opioids during pregnancy.

With all doses of methadone and buprenorphine there is a risk of NAS, but it varies with individuals.

Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health in the US says in the editorial: “High prescribing rates of opioids to women during pregnancy have probably contributed to recent increases in neonatal abstinence syndrome.

“The steep increase in the number of opioid prescriptions dispensed in the United States has been associated with a parallel rise in their misuse, fatal overdoses, and heroin use. More recently, attention has been focused on the large increase in the number of infants born with neonatal abstinence syndrome.”

Opioids should only be prescribed to pregnant women with severe pain that cannot be controlled with less harmful treatments, Volkow recommends, and ideally be limited to a short-term use to reduce the risk of associated harms.

However, she adds that if long-term use is unavoidable, such as in cases of women who need of treatment for heroin addiction, then careful assessment and monitoring should be carried out to reduce the risk of overdose, misuse and NAS.

* Opioids in pregnancy. BMJ 2016;352:i19. doi: 10.1136/bmj.i19

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