Opioids & Pregnancy
Prenatal substance exposure occurs when a pregnant person uses alcohol, tobacco and/or drugs, whether prescribed or not, at any time during pregnancy. Alcohol and other substance use during pregnancy can lead to serious long-lasting consequences for birthing people and infants including miscarriage, still birth, fetal alcohol spectrum disorders (FASD) and neonatal abstinence syndrome (NAS).
Research & Statistics
- Drug Overdose Deaths Among Women Aged 30–64 Years — United States, 1999–2017
The drug epidemic in the United States continues to evolve. The drug overdose death rate has rapidly increased among women, although within this demographic group, the increase in overdose death risk is not uniform. From 1999 to 2010, the largest percentage changes in the rates of overall drug overdose deaths were among women in the age groups 45–54 years and 55–64 years; however, this finding does not take into account trends in specific drugs or consider changes in age group distributions in drug-specific overdose death rates.
- Effective Treatments for Opioid Addiction
Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.
- Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts
Opioid-related overdose deaths have more than quadrupled over the past fifteen years, representing a public health emergency. The rates of heroin use and prescription opioid-related overdose deaths are rising faster in women than in men, particularly women of reproductive age. Multiple states have identified opioid-related overdoses as a major contributor to pregnancy-associated deaths. Among all pregnancy associated deaths, 11–20% were due to opioid-overdose.
- Implications of perinatal buprenorphine exposure on infant head circumference at birth
To determine the potential impact of prenatal buprenorphine exposure on head circumference at birth and analyze whether head circumference may be related to maternal buprenorphine dose at delivery, delayed maternal entry into buprenorphine treatment or exposure to a variety of other medications and substances.
- Opioid Use and Opioid Use Disorder in Pregnancy
ABSTRACT: Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal.
- Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24–48?hours post birth
The rising issue of opioid use during pregnancy poses an increased risk of fetal exposure to opioids in-utero and the development of neonatal abstinence syndrome (NAS). The cessation of exposure to opioids upon birth causes elevated levels of norepinephrine in the circulation enhancing sympathetic arousal. Skin conductance (SC) detects sympathetic-mediated sweating while the Neonatal Facial Coding System (NFCS) depicts facial expressions of stress and pain. We hypothesize that there will be a direct correlation between SC and NFCS scores, such that neonates with prenatal opioid exposure will have higher SC and facial responses to pain/stress as compared with healthy neonates without prenatal opioid exposure.
- The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families
Despite a significant volume of news and research on the tragic toll of opioids, one aspect has gone relatively unnoticed: the impact on children and families.
A United Hospital Fund project is working to change that by shining a light on the epidemic’s long-lasting and destructive “ripple effects” on children and adolescents whose parents are addicted and on kinship caregivers who often end up caring for these young people.
- US National Trends in Pediatric Deaths From Prescription and Illicit Opioids, 1999-2016
Question How have US mortality rates for pediatric opioid poisonings changed over the past 2 decades?
Findings In this cross-sectional study, 8986 children and adolescents died between 1999 and 2016 from prescription and illicit opioid poisonings. During this time, the mortality rate increased 268.2%.
Meaning Pediatric-specific and family-centered interventions are needed to address pediatric opioid poisonings, a growing public health problem in the United States.
What are Opioids?
Prescription opioids are painkillers often used for pain after an injury, surgery or dental work. They include codeine, morphine and oxycodone. Non-prescription or “street drugs” include heroin.
A prescription medication is one your medical provider gives you to treat a health condition. Some common prescriptions opioids are:
Buprenorphine (Belbuca, Buprenex, Butrans, Prouphine)
Fentanyl (Actiq, Duragesic, Sublimze)
Hydromophone (Dalaudid, Exalgo)
Methadone (Dolophine, Methadose)
Oxycodone (OxyContin, Percodan, Percocet)
Tramadol (ConZip, Ryzollt, Ultram)
The illegal drug, heroin, is an opioid. Heroin is often laced with other drugs such as fentanyl or cocaine which makes it extremely dangerous.
Opioids are highly addictive. Along with relieving pain, opioids release chemicals in the brain that make one feel calm and experience an intense feeling of euphoria. This can lead to over use and then addiction. Once addicted to a prescription opioid, people may start to buy the drug illegally and may start using heroin. Addiction to opioids is called an opioid use disorder.
Is there treatment for opioid use disorder during pregnancy?
Yes. Medicated Assisted Treatment (MAT) is the standard of care for pregnant people with opioid use disorders. MAT stabilizes the birthing person, prevents withdrawal and assists the birthing person with making connections to prenatal care. Abrupt withdrawal of the birthing person from opioids is not recommended due to the high rates of preterm labor, fetal distress or miscarriage. MAT with methadone or buprenorphine have been shown to be safe and effective in treating opioid dependence during pregnancy. MAT should be comprehensive and include prenatal care, psychosocial therapy and support services to assist the birthing person in maintaining their recovery. MAT may not eliminate the risk of NAS, however, it provides the best chance for a healthy parent and newborn as well as the best chance for the birthing person's continued recovery. Once the baby is born, the parent will continue with MAT and work with their health care provider about future MAT.
Another treatment that is used in conjunction with MAT is inpatient or outpatient drug use disorder treatment. This involves counseling, both individual and group as well as education and support in developing a drug free lifestyle.
Can opioids cause problems for the baby during pregnancy and after birth?
Yes. Using opioids during pregnancy could result in miscarriage, preterm labor or premature birth, birth defects, small for gestational age, low birth weight or being born weighing less than 5 pounds, 8 ounces, or neonatal abstinence syndrome.
Is it safe to suddenly quit taking opioids during pregnancy?
No. Suddenly quitting or “going cold turkey” during pregnancy can cause severe issues for the expectant mother and the unborn baby. Quitting opioids suddenly may increase the risk of placental abruption, a serious condition in which the placenta separates from the uterine wall before birth. It can cause heavy bleeding that can be life threatening to the birthing person and lead to premature birth. It is important that the birthing person speak with their prenatal health care provider prior to stopping opioid use. If the birthing person is addicted to opioids, they may be referred for Medicated Assisted Treatment. Neonatal Abstinence Syndrome is easier to treat for babies whose moms get MAT during pregnancy.
What is Neonatal Abstinence Syndrome (NAS)?
Neonatal Abstinence Syndrome or NAS refers to a treatable condition that newborns experience after chronic exposure to certain substances, primarily opioids, while in utero. While repeated exposure to benzodiazepines, barbiturates, and alcohol have also been linked to infant withdrawal symptoms, chronic opioid use is the most common source of NAS.
Newborns may exhibit symptoms that include difficulty feeding, irritability, high-pitched cry, problems with calming/settling, and difficulty sleeping. These symptoms may last anywhere from a few days to several weeks after birth. It is recommended by the American Academy of Pediatrics that newborns with NAS initially receive treatment using non-pharmacologic means. These include rooming-in, gentle handling, swaddling, and breastfeeding also known as Eat, Sleep, Console. Medication is indicated to relieve more severe symptoms of NAS when the other interventions have been unsuccessful.