Neonatal Abstinence Syndrome from Opioid Use in Pregnancy a Growing Problem

Ever year, the number of infants born with symptoms of opioid withdrawal, known as neonatal abstinence syndrome, increases and this increase coincides with the surge in the nationwide opioid abuse epidemic, which has spread to every group of people in the United States. Neonatal abstinence syndrome is a withdrawal syndrome occurring among infants exposed to opioids in utero and while some opioid drugs are more likely to cause neonatal abstinence syndrome than others, nearly all have some adverse effect on the exposed baby. Infants experiencing withdrawal from opioids are typically irritable and often have a difficult time being comforted. Some babies exposed to opioid drugs in utero may even require treatment with medications to address severe withdrawal symptoms, such as seizures, or to help relieve the discomfort associated with opioid withdrawal.

Neonatal Abstinence Syndrome

The opioid abuse epidemic in the United States is a serious public health problem that affects adults and infants alike. Not only has the rise of opioid abuse nationwide resulted in a growing number of overdoses and drug-related deaths, it has also resulted in a dramatic increase in the number of cases of neonatal abstinence syndrome (NAS) diagnosed in children born to women who used opioid drugs while pregnant. NAS is the term used to describe a group of problems that may occur in newborns exposed to prescription or addictive illegal drugs while in the mother’s womb. NAS is a withdrawal syndrome and the symptoms associated with the syndrome occur as the baby goes through withdrawal from exposure to the drug or drugs used by the mother during pregnancy.

Infants with neonatal abstinence syndrome spend an average of 16 days in the hospital and experience a wide range of symptoms, from central nervous system irritability (tremors, seizures, increased muscle tone and high-pitched crying) to gastrointestinal dysfunction (feeding difficulties) and temperature instability. NAS can result from maternal use of prescription opioid drugs, which has increased nationally in recent years, or from opioid abuse by an expectant mother. The opioids most commonly abused by people in the United States include prescription painkillers like Vicodin, OxyContin, Percocet, Fentanyl and Codeine and illicit opioids like heroin.

According to a study published this month in the journal JAMA Pediatrics, the rate of neonatal abstinence syndrome in the United States has climbed sharply from approximately 1.5 per 1,000 hospital births in 2004 to eight per 1,000 hospital births in 2014. Furthermore, the costs associated with treating NAS from opioid use in pregnancy has increased from $316 million in 2012 to $572.7 million in 2016, which illustrates how the opioid abuse problem has grown in recent years. In 2016, the U.S. Centers for Disease Control and Prevention (CDC) issued a report indicating that the number of infants born with NAS had increased more than 300% over the previous decade and called for more attention to be paid to developing opioid abuse interventions for pregnant women and reducing the inappropriate prescription of opioid painkillers.

Overprescribing Opioid Drugs

In recent years, there has been a dramatic increase in the prescription of powerful opioids to treat even mild to moderate pain, despite the serious health risks associated with this class of drugs. While hundreds of lawsuits have been filed against the manufacturers of opioid drugs for their aggressive and misleading marketing tactics, far too little attention has been paid to the role of physicians in contributing to the nationwide opioid epidemic. In one study analyzing almost 350,000 prescriptions for opioid drugs written by nearly 20,000 surgeons from 2011 to 2016, researchers at Johns Hopkins School of Public Health found that surgeons were regularly prescribing opioid drugs at rates that exceeded current accepted guidelines. Some surgeons wrote prescriptions for more than 100 pills in the week after surgery, even for procedures that caused patients relatively little pain, with instructions to take one to two pills every four to six hours.

Side Effects of Maternal Opioid Use

The most recent national statistics indicate that 10.3 million Americans ages 12 and older abused opioid drugs in 2018, and the rising crisis has had devastating consequences for those directly affected by opioid abuse and their loved ones. In 2017, more than 70,000 people died from a drug overdose, making it the leading cause of injury-related death in the United States, and of those deaths, nearly 68% involved a prescription or illicit opioid drug. Unfortunately, anyone who uses a prescription opioid can become addicted to the drug, and once addicted, it can be difficult to stop using the drug, even during pregnancy.

Opioid use by pregnant women can result in serious health consequences for both mother and child. Women who use opioid drugs while pregnant face an increased risk of overdose or death and babies exposed to powerful opioids in utero are more likely to be born prematurely and are at increased risk for birth defects, breathing and feeding problems, cognitive impairment and developmental delays. The specific symptoms that may occur in an infant with NAS depend on a number of factors, including the type of drug or drugs used by the pregnant mother, how much of the drug was used, how long the drug was used and how the mother’s body breaks down the drug.