Infants born to women taking prescription opioids were more likely to have neonatal abstinence syndrome (NAS) if their mothers smoked tobacco or took selective serotonin reuptake inhibitors (SSRIs), according to a recent study. Cumulative opioid exposure and opioid type (maintenance and long-acting) also increased the risk of NAS.
“The American Academy of Pediatrics recommends that all opioid-exposed infants be observed in the hospital for 4 to 7 days after birth. However, our data suggest there was a wide variability in an infant’s risk of drug withdrawal based on opioid type, dose, SSRI use, and number of cigarettes smoked per day by the mother,” reported Dr. Stephen W. Patrick of Vanderbilt University, Nashville, Tenn. “Future studies should evaluate new care models for opioid-exposed infants at different risk levels of developing NAS,” wrote Dr. Patrick and his associates [Pediatrics 2015 April 13 [doi: 10.1542/peds.2014-3299]).
Dr. Patrick’s team analyzed prescription data and vital statistics of 112,029 pregnant women and their newborns who were enrolled in the Tennessee Medicaid program between 2009 and 2011. Of these, 28% of the women filled at least one prescription for opioids; these included 96.2% taking short-acting medications, 2.7% receiving maintenance treatment for substance use disorders and 0.6% taking long-acting medications.
Among women taking prescription opioids, 5.3% had depression, 4.3% had an anxiety disorder, 41.8% smoked, 4.3% had been prescribed SSRIs within 30 days before birth, 8.3% had headache or migraine, and 23.7% had musculoskeletal disease, compared to 2.7%, 1.6% and 25.8%, 1.9%, 2.0% and 5.8%, respectively, for mothers not taking opioids.
Nearly a third of women on maintenance therapy (29.3%) had infants with NAS while 14.7% of mothers taking long-acting opioids and 1.4% of women taking short-acting preparations had newborns with NAS. Newborns were twice as likely to develop NAS if their mothers took SSRIs (odds ratio, 2.08), and their risk of NAS increased in a dose-response fashion with the number of daily cigarettes their mothers smoked.
NAS rates nearly doubled during the course of the study, landing at 10.7 per 1,000 births in the final year. Among the 1,086 newborns diagnosed with NAS, 21.2% had low birth weight, 16.7% were preterm, 28.7% had respiratory diagnoses, 13.1% had feeding difficulties, 7.2% had sepsis, and 3.7% had seizures. Among those exposed to opioids who did not develop NAS, 11.8% had low birth weight, 11.6% were preterm, 10.1% had respiratory diagnoses, 2.6% had feeding difficulties, 2.3% had sepsis and 0.4% had seizures. Among unexposed newborns, 9.9% had low birth weight, 11% were preterm, 8.8% had respiratory diagnoses, 2.3% had feeding difficulties, 1.9% had sepsis, and 0.3% had seizures.
“Public health efforts should focus on limiting inappropriate [opioid pain relievers] and tobacco use in pregnancy,” the authors wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”
The research was funded by the Tennessee Department of Health and the National Institutes of Health. The authors reported no disclosures.