Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

Abstract

In April 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited experts to a workshop to address numerous knowledge gaps and to review the evidence for the screening and management of opioid use in pregnancy and neonatal abstinence syndrome. The rising prevalence of opioid use in pregnancy has led to a concomitant dramatic fivefold increase in neonatal abstinence syndrome over the past decade. Experts from diverse disciplines addressed research gaps in the following areas: 1) optimal screening for opioid use in pregnancy; 2) complications of pregnancy associated with opioid use; 3) appropriate treatments for pregnant women with opioid use disorders; 4) the best approaches for detecting, treating, and managing newborns with neonatal abstinence syndrome; and 5) the long-term effects of prenatal opioid exposure on children. Workshop participants identified key scientific opportunities to advance the understanding of opioid use disorders in pregnancy and to improve outcomes for affected women, their children, and their families. This article provides a summary of the workshop presentations and discussions.

Opioid Replacement for Pregnant Mothers With Opioid Use Disorder and Fetal Neurodevelopment: A Review

“…Enabling a mother to room-in with her newborn while the newborn is getting advanced care or monitoring has also been shown to lower the incidence of NAS [24,25]. Providing maternal support to improve rates and duration of breastfeeding is also important, because evidence shows that breastfeeding not only decreases severity of NAS but also reduces maternal stress and enhances maternal confidence and mother-child bonding [6]. Ongoing medical and social support assistance to the family should include chemical dependency and relapse prevention programs [6], nutritional and financial support [26], and screening and support for cooccurring mental health conditions, trauma, and victimization [3].…”

“…Providing maternal support to improve rates and duration of breastfeeding is also important, because evidence shows that breastfeeding not only decreases severity of NAS but also reduces maternal stress and enhances maternal confidence and mother-child bonding [6]. Ongoing medical and social support assistance to the family should include chemical dependency and relapse prevention programs [6], nutritional and financial support [26], and screening and support for cooccurring mental health conditions, trauma, and victimization [3]. Preventive interventions that provide enriched environments and high-quality care for infants and children are beneficial to neurodevelopmental outcome [12].…”

“…Uniformly, published consensus statements and practice-guidelines state that the potential risk of in utero opioid replacement is strongly outweighed by its benefits [3,4,6]. These benefits include improved prenatal care, longer gestation, and reduced incidences of fetal demise, placental abruption and fetal passage of meconium [3,4].…”

“…The manifestation of these withdrawal symptoms in the neonate is referred to as neonatal abstinence syndrome (NAS) [6]. The symptoms of NAS include features of hyperactivity of the central and autonomic nervous system [6].…”

“…Hyperactivity of the autonomic nervous system results in symptoms such as sweating and mottling of the skin and enteric symptoms such as vomiting and diarrhea. NAS severity is graded with a validated clinical tool, called the Modified Finnegan Scoring System and is managed by pharmacological treatment with oral morphine or methadone [6].…”