Opioid

Opioid use during pregnancy comes with many risks to the mother and fetus. In utero, there is a risk of preeclampsia, premature labor and rupture of membranes, placental insufficiency, abruptio placentae, intrauterine growth retardation, and intrauterine death (Ross, Graham, Money, & Stanwood, 2014). While in utero, opioids can also cross the placenta and lead to abnormal growth and development, birth defects, and opioid uptake (Yazdy, Desai, & Brogly, 2015). Neonatal abstinence syndrome (NAS) is a condition in which opioid exposed infants experience drug withdrawal symptoms shortly after birth (Krans & Patrick, 2016).

NAS is characterized by central nervous system hyperirritability, autonomic nervous system dysfunction, and gastrointestinal disturbances (Stover & Davis, 2015). Observed symptoms may include: irritability, excessive crying, poor sleep, increased muscle tone, tremors, hyperthermia, loose stools, excessive movements, yawning, sweating, sneezing, and nasal stuffiness (Stover & Davis, 2015). Some infants may also experience seizures (Stover & Davis, 2015). Neonates with NAS typically require prolonged hospitalization and pharmacotherapy with morphine or methadone (Yazdy et al., 2015).

In this scenario, it is also going to be important for the mother to get clean. Opioid withdrawal is not recommended during pregnancy, however, medication assisted treatment can be started while pregnant (Krans & Patrick, 2016). Mental health assessments and counseling will also be important for this mother. For women that are undergoing medication assisted treatment with methadone or buprenorphine, the AAP and ACOG both encourage breastfeeding (Stover & Davis, 2015). In these cases, breastfeeding is associated with a decrease in the incidence and severity of NAS (Stover & Davis, 2015).

The long-term consequences of opioid exposure in utero and NAS have been difficult to determine (Stover & Davis, 2015). This is due to small study sizes and issues differentiating the effects of in utero exposures versus postnatal treatments versus environmental influences (Stover & Davis, 2015). Although, studies have found that in general, children with opioid exposures are more likely to have psychiatric issues, attention deficit disorders, and disruptive behaviors (Stover & Davis, 2015). Other effects may also include smaller brains, a thinner cortex, and reduced cognitive abilities (Stover & Davis, 2015).

References

Krans, E. E., & Patrick, S. W. (2016). Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic. Obstetrics and Gynecology, 128(1), 4-10. https://dx.doi.org/10.1097%2FAOG.0000000000001446

Ross, E. J., Graham, D. L., Money, K. M., & Stanwood, G. D. (2014). Developmental consequences of fetal exposure to drugs: What we know and what we still must learn. Official Publication of the American College of Neuropsychopharmacology, 40(1), 61-87. https://dx.doi.org/10.1038%2Fnpp.2014.147

Stover, M. W., & Davis, J. M. (2015). Opioids in pregnancy and neonatal abstinence syndrome. Seminars in Perinatology, 39(7), 561-565. https://dx.doi.org/10.1053%2Fj.semperi.2015.08.013

Yazdy, M. M., Desai, R. J., & Brogly, S. B. (2015). Prescription opioids in pregnancy and birth outcomes: A review of the literature. Journal of Pediatric Genetics, 4(2), 56-70. https://dx.doi.org/10.1055%2Fs-0035-1556740