Prenatal exposure to opiates

Abstract

Opiate use has been described for thousands of years. In this century, clinical features of the “neonatal abstinence syndrome” have been amply documented in the medical literature. Indeed, the abuse of “recreational” drugs continues at an alarming rate and results in a high number of adverse maternal‐fetal outcomes even as we near the end of the twentieth century. These consequences persist despite the myriad of medical advances that have resulted in the lowest perinatal mortality on record. The effects of opiate exposure on the developing fetus have been extensively described in the literature on animal research, in which neurodevelopmental and behavioral abnormalities have been linked to brain region‐specific cellular and molecular findings. The human clinical literature clearly defines the symptoms, timing, and frequency of opiate withdrawal in infants exposed prenatally and documents treatment of withdrawal, which is dependent on the severity of symptoms. A panoply of similarities exist. The adverse complications of maternal opiate addiction during the human prenatal and postnatal period are most significant for the fetus and infant, resulting in increased morbidity and mortality. Other consequences include stillbirth, premature birth, low birth weight, small head circumference at birth and during childhood, poor postnatal somatic growth, transient hypertonia, maladaptive responses to physiologic stresses of hypoxia and hypercarbia, and an increased rate of sudden infant death syndrome, as well as a variety of neurodevelopmental and cognitive delays. Although the factors relating to socioeconomic status, nutrition, and multisubstance abuse add to the challenges of acquiring reliable data, a vast amount of animal and human data suggest that opioids play a critical role in developmental processes that affect the vulnerability and plasticity of the immature brain. In addition, affected infants and children are subject to significant emotional, social, and environmental instability throughout their lives. This must certainly contribute to their neurobehavioral dysfunction. Regardless of these findings, opiates do not appear to have a specific teratogenic effect. © 1995 Wiley‐Liss, Inc.

Outreach developmental services to children of patients in treatment for substance abuse

“…The high prevalence of prematurity, microcephaly, and hypertonia reported here has been previously described for children exposed in utero to heroin or cocaine or both. [5][6][7][8] Of the 93 women who volunteered birth histories, 40 self-reported illicit drug use during pregnancy. Dysmorphic features of a diverse nature were seen in 10% of the children evaluated, although only 4% followed a pattern associated with a described syndrome.…”

“…Studies have shown that needle exchange programs do not increase rates of drug use 6 or increase numbers of discarded needles or syringes 7 ; because drug use has been associated with crime, 8,9 however, there are concerns that crime rates may increase in areas surrounding needle exchange programs after their introduction.…”