Opioids in Pregnancy: What Raises the Risk for Neonatal Abstinence?

William T. Basco, Jr., MD, MS


August 24, 2015

Prescription Opioid Epidemic and Infant Outcomes

Patrick SW, Dudley J, Martin PR, et al
Pediatrics. 2015;135:842-850

Opioid Exposure and Neonatal Abstinence

Coincident increases have been observed in prescriptions for oral opioids in pregnancy and in neonatal abstinence syndrome (NAS), characterized by a range of symptoms, from poor feeding, irritability, and hypertonicity, to other neurologic symptoms, such as seizures. This study used Tennessee Medicaid data and other vital records to assess maternal use of opioids and other drugs during the 30 days prior to delivery to determine whether opioid use patterns were associated with risk for NAS. Specifically, the researchers evaluated whether maternal cumulative opioid exposure, the type of opioid, tobacco smoke exposure, and use of selective serotonin reuptake inhibitors (SSRIs) were associated with NAS in the women's offspring.

Mothers aged 15-44 years who were enrolled in the Medicaid program and gave birth in 2009-2011 comprised the cohort. Using pharmacy claims, the study authors identified women who received short-acting opioids, long-acting opioids, maintenance opioids, and SSRIs. Birth certificates provided data on tobacco smoke exposure. Maternal data included age, education, number of births, race, hepatitis status, HIV status, and documentation of depression or anxiety. The researchers attempted to identify the reason for opioid use: acute pain, chronic pain, headache, or musculoskeletal diseases. Infants diagnosed with NAS were identified by International Statistical Classification of Disease–9 codes. The study authors also looked for the presence of such clinical signs as respiratory difficulties, feeding difficulties, seizures, sepsis, necrotizing enterocolitis, and other symptoms and clinical entities previously known to be associated with NAS.


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