A new, prospective study has assessed the effects of maternal opioid use during pregnancy on the prenatal risks and short and long-term physical and neurodevelopmental outcomes in infants exposed to opioids in utero. The results demonstrate that opioid use during pregnancy is associated with greater risk of pregnancy complications and impaired infantile development.
Between 1999 and 2014, opioid use amongst women delivering newborns in the USA increased four-fold.
Opioid use during pregnancy is linked with the prevalence of neonatal abstinence syndrome (NAS); an infantile withdrawal disorder resulting from in utero opioid exposure. In the USA, NAS requires pharmacological intervention and hospitalization for an average of 16 days.
A novel, longitudinal study has evaluated data on 8509 mother–newborn pairs, from the Boston Birth Cohort. This low-income, urban, multiethnic group registered mother–newborn pairs at birth at the Boston Medical Center (MA, USA) and was employed for pre- and perinatal analysis.
3153 of the 8509 children qualified for postnatal outcomes study analysis, as they continued to receive pediatric care at Boston Medical Center.
Eligible mothers delivered singleton live births after 1998. Twins, triplets, newborns with major birth defects, births by IVF and children with congenital chromosomal abnormalities were all excluded from the study cohort.
454 of the 8509 children (5.3%) analyzed in the study had been exposed to opioids in utero; this was defined as maternal self-reported opioid use during pregnancy and/or clinical NAS diagnosis.
Researchers compared the demographic and epidemiological traits of mothers who used opioids during pregnancy with those who did not use opioids during pregnancy. Prenatal risk factors, pregnancy complications, birth outcomes and postnatal outcomes of children born to opioid-using mothers and non-using mothers were all also investigated.
Compared with non-users, mothers who used opioids during pregnancy had increased risk of pregnancy complications such as gestational diabetes and lower body mass indices.
Opioid use during pregnancy was also associated with greater risk of restricted fetal growth, preterm birth, poor physiological development, emotional disturbance and attention disorder prevalence.
In the study, the authors noted that “…the findings of this study could have multiple clinical and public health implications…efforts to prevent maternal opioid use and mitigate its health consequences require a longitudinal approach that addresses physical and mental health sequelae for mothers and children.”
The authors continued: “…from a health economics perspective, the opioid epidemic is an intergenerational problem. Successfully addressing it will not only benefit current and future generations but also mitigate exorbitant health care expenditures.”
Importantly, the authors note that mothers who used opioids during pregnancy concurrently exhibited “…higher rates of smoking, drinking, and using other illicit drugs during pregnancy compared with their non-exposed counterparts.
In the study, the authors thus concluded: “…the effect of opioids is still difficult to disentangle from effects of other childhood exposures. Policy and programmatic efforts to prevent NAS and mitigate its health consequences require more comprehensive longitudinal and intergenerational research.”
Azuine RE, Ji Y, Chnag HY et al. Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population. JAMA Netw. Open; 2(6) (2019);