Don’t prescribe opioid pain medication in pregnancy without fully weighing the risks to the woman and her fetus, and discussing these risks with the patient.
|Rationale and Comments:||In utero exposure to opioids can lead to risks for the infant, including neonatal abstinence syndrome and/or developmental deficits affecting behavior and cognition. Pregnant women’s use of opioids dramatically increased from 1.19 per 1,000 hospital births in 2000 to 5.63 per 1,000 hospital births in 2009. Prescription opioids are among the most effective medications for the treatment of pain. However, regular or long-term use of opioids can create physical dependence and in some cases, addiction. Women who are prescribed, or continue to use, opioids during pregnancy may not understand the risks to themselves or their babies. Pregnant women and their fetuses are an inherently vulnerable population, and opioid dependence increases their vulnerability. Women using opioids during pregnancy were shown to have higher rates of depression, anxiety, and chronic medical conditions, as well as increased risks for preterm labor, poor fetal growth, and stillbirth. Women who used opioids during pregnancy were four times as likely to have a prolonged hospital stay compared to nonusers and incurred significantly more per-hospitalization cost. Neonatal abstinence syndrome occurs in newborns that are exposed to substances, typically opioids, while in their mothers’ wombs. In utero exposure to these substances can cause a newborn to experience withdrawal symptoms after birth. Symptoms of neonatal abstinence syndrome vary depending on the type and amount of the substance that the mother used, how the mother and fetus metabolize the drug, and how long the mother used the drug. Symptoms of neonatal abstinence syndrome range from blotchy skin and sneezing, to respiratory complications, low birth weight, prematurity, feeding difficulties, extreme irritability, and seizures.|
|References:||• Opioid abuse, dependence, and addiction in pregnancy. ACOG committee opinion number 524. Washington (DC): American College of Obstetricians and Gynecologists. 2012 May. Available from: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy.
• Criminalization of pregnant women with substance use disorders. J Obstet Gynecol Neonatal Nurs. 2015 Jan-Feb; 44(1), 155–7.
• Medication use in pregnancy: a public health concern. Atlanta (GA): Centers for Disease Control and Prevention. 2015 Jan 16 [cited 2016 May 15]. Available from: http://www.cdc.gov/pregnancy/meds/treatingfortwo/facts.html.
• Opioid painkillers widely prescribed among reproductive age women. Atlanta (GA): Centers for Disease Control and Prevention. 2015 Jan 22 [cited 2016 May 22]. Available from: http://www.cdc.gov/media/releases/2015/p0122-pregnancy-opioids.html.
• Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40.
• Addressing prescription drug abuse in the United States: current activities and future opportunities. Washington (DC): Department of Health and Human Services. 2013 Sep. 36 p. Volkow ND. Prescription opioid and heroin use. Bethesda (MD): National Institute on Drug Abuse. 2014 Apr.
• Whiteman VE, Salemi JL, Mogos MF, Cain MA, Aliyu MH, Salihu HM. Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy. 2014:906723.