Opioid use during pregnancy can have significant implications for both the mother and the developing fetus.
Opioids are a class of drugs that include prescription painkillers (e.g.,
oxycodone,
hydrocodone) and illicit substances like
heroin.
Opioid use during pregnancy is associated with an increased risk of complications, including an elevated risk of
preterm birth,
low birth weight,
intrauterine growth restriction, and
stillbirth. Opioids are substances that can cross the placenta, exposing the developing fetus to the drugs. This exposure can potentially lead to various adverse effects on fetal development, including an increased risk of
birth defects. One of the most well-known consequences of maternal opioid use during pregnancy is the risk of
neonatal abstinence syndrome (NAS). NAS occurs when the newborn experiences
withdrawal symptoms after birth due to exposure to opioids in the womb. Maternal opioid use during pregnancy can also have long-term effects on the child's development. These effects may include cognitive and behavioral problems, as well as an increased risk of
substance use disorders later in life.
Pain management and concerns
Opioid usage is common among pregnant women and is on the rise.[1] Opioid drugs are used for various reasons during pregnancy, with
pain being a frequent issue. Conditions like
pelvic and
lower back pain, occurring in around 68 to 72% of pregnancies, are commonly treated with these medications.[1][2][3] Moreover, other sources of pain like
muscle aches,
migraines, and
joint pain are commonly reported during pregnancy.[1][4]
However, when it comes to chronic pain, guidelines from the
American Pain Society recommend discussing the advantages and disadvantages of chronic opioid therapy with women and, if possible, limiting or avoiding opioid use during pregnancy due to potential risks to the
fetus.[1][5] Even though there is evidence suggesting harmful impacts on fetal development caused by prescription opioids,[6][7][8][9] research conducted in both Europe and the United States consistently shows elevated levels of prescription opioid use during pregnancy, whether it's for medical reasons or due to opioid
dependency.[1] It's important to note that prescription opioids encompass a range of medications, and the potential effects on the fetus may differ between different medications within the same drug class.[1]
The use of opioids in the early stages of pregnancy is associated with an elevated risk of
congenital anomalies. Specifically, there is a two-fold increased likelihood of certain birth defects, including congenital heart defects,
gastroschisis, and
neural tube defects.[10][9][6] The risk of preterm birth and neonatal complications is reduced to some extent when
dextropropoxyphene or
codeine is used in comparison to other
opioid analgesics.[13][14]
Neurodevelopment
The potential
impact on the neurodevelopment of infants exposed to opioids before birth is another significant concern. A recent meta-analysis revealed noteworthy deficiencies in cognitive, psychomotor, and behavioral abilities in infants and preschool-aged children who had experienced chronic intrauterine opioid exposure.[10] Children who experienced neonatal abstinence syndrome were notably more prone to hospitalizations due to cognitive impairments,
communication, speech, or language disorders,
autism spectrum disorder, and behavioral problems, particularly those concerning emotional control.[15][16]
Neonatal abstinence syndrome occurs when newborns go through withdrawal from
opiates and is linked to dysfunction in the central and autonomic nervous systems, the respiratory system, and the gastrointestinal tract.[13] Additionally, there is an elevated risk of neonatal abstinence syndrome associated with the medical use of certain
opioid analgesics, such as
tramadol,
codeine, and
propoxyphene.[13]
Management
Pregnant women with
opioid use disorder have treatment options including
methadone,
naltrexone, or
buprenorphine to decrease opioid usage and enhance treatment adherence.[17][18] Current guidelines suggest that methadone and buprenorphine are equally viable choices. Nevertheless, recent research suggests that buprenorphine may offer certain advantages over methadone.[19]
^Chou, Roger; Fanciullo, Gilbert J.; Fine, Perry G.; Adler, Jeremy A.; Ballantyne, Jane C.; Davies, Pamela; Donovan, Marilee I.; Fishbain, David A.; Foley, Kathy M.; Fudin, Jeffrey; Gilson, Aaron M.; Kelter, Alexander; Mauskop, Alexander; O'Connor, Patrick G.; Passik, Steven D.; Pasternak, Gavril W.; Portenoy, Russell K.; Rich, Ben A.; Roberts, Richard G.; Todd, Knox H.; Miaskowski, Christine (2009).
"Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain". The Journal of Pain. 10 (2). Elsevier BV: 113–130.e22.
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^Rothman, Kenneth J.; Fyler, Donald C.; Goldblatt, Allan; Kreidberg, Marshall B. (1979). "Exogenous hormones and other drug exposures of children with congenital heart disease". American Journal of Epidemiology. 109 (4). Oxford University Press (OUP): 433–439.
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^Källén, Bengt; Reis, Margareta (2012). "Neonatal Complications After Maternal Concomitant Use of SSRI and Other Central Nervous System Active Drugs During the Second or Third Trimester of Pregnancy". Journal of Clinical Psychopharmacology. 32 (5). Ovid Technologies (Wolters Kluwer Health): 608–614.
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^Chanal, Corinne; Mazurier, Evelyne; Doray, Bérénice (2022). "Use of Psychoactive Substances during the Perinatal Period: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives". Journal of Midwifery & Women's Health. 67 (S1). Wiley: S17–S37.
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^Tran, Tran H.; Griffin, Brooke L.; Stone, Rebecca H.; Vest, Kathleen M.; Todd, Timothy J. (2017). "Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women". Pharmacotherapy: The Journal of Human Pharmaoclogy and Drug Therapy. 37 (7). Wiley: 824–839.
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