Infants uncovered to opioids throughout being pregnant are in danger for neonatal opioid withdrawal syndrome (NOWS); nonetheless, in accordance with a latest research, the danger is bigger in infants uncovered to sure opioids, together with methadone.
The prevalence of neonatal opioid withdrawal syndrome (NOWS) in the US elevated from 1.2 to eight.8 per 1,000 births between 2000 and 2016. Most research have checked out danger for withdrawal signs throughout the complete class of opioids; nonetheless, a latest research signifies that there are clear variations in danger for NOWS relying on the kind of opioid used, seeing the best danger in infants uncovered to stronger opioid agonists and people with an extended half-life. (Essential Notice: This research centered solely on prescribed opioids and didn’t embody illicit opioid use or using opioids to deal with opioid use dysfunction.)
This cohort research analyzed administrative claims knowledge of Medicaid-insured moms and newborns in 46 states and Washington DC, together with 48,202 opioid-exposed pregnancies with liveborn infants. Opioid publicity was outlined because the dispensation of two or extra opioid prescriptions throughout being pregnant, inside 90 days of supply.
Amongst opioid-exposed pregnancies with reside newborns, a complete of 1069 neonates (2.2%) had NOWS and 559 (1.2%) had extreme NOWS. Relative to hydrocodone, opioid withdrawal syndrome was 2- to 3-fold extra frequent in infants uncovered to stronger agonists and opioids with an extended half-life: oxycodone (adjusted relative danger or aRR 1.87; 95% CI, 1.66-2.11), morphine (aRR 2.84; 95% CI, 1.30-6.22), and methadone (aRR 3.02; 95% CI, 2.45-3.73).
Implications for Moms Receiving Remedy Assisted Remedy for Opioid Use Dysfunction
Whereas this research included solely moms utilizing methadone for ache administration and didn’t embody infants born to moms utilizing methadone or buprenorphine for the remedy of opioid use dysfunction (OUD), the discovering of considerably increased charges of NOWS in infants with prenatal publicity to methadone is related to the remedy of moms with OUD.
Buprenorphine (not included within the present research) and methadone are each opioids and have each been proven to be secure and efficient therapies for opioid use dysfunction throughout being pregnant. Sufferers have to be knowledgeable that NOWS should happen in infants whose moms obtain these drugs. Though each drugs could also be related to NOWS, the present analysis doesn’t help stopping or decreasing the dose of treatment close to the time of supply as a way to forestall NOWS, as this will likely result in elevated illicit drug use and better danger to the fetus.
As a result of the postpartum interval is a time of elevated danger for relapse in ladies with substance use issues (SUDs), you will need to proceed to supply help and to have interaction ladies with opioid use issues in constant remedy after supply. As well as, parenting a toddler with NOWS is a danger issue for opioid use relapse; thus, you will need to educate ladies receiving both buprenorphine or methadone that there’s a danger of NOWS and to organize them for this risk. Equally you will need to decrease stigma and to teach different well being care suppliers, in addition to members of the family, that NOWS on this setting will not be an indication of illicit opioid use.
Ruta Nonacs, MD PhD
Esposito DB, Huybrechts KF, Werler MM, Straub L, Hernández-Díaz S, Mogun H, Bateman BT. Characteristics of Prescription Opioid Analgesics in Pregnancy and Risk of Neonatal Opioid Withdrawal Syndrome in Newborns. JAMA Netw Open. 2022 Aug 1;5(8):e2228588.
