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Risks of Opioid Misuse During Pregnancy

Untreated opioid use disorder during pregnancy can have life-threatening effects for the unborn baby. Frequent changes in opioid levels for the mother can expose the baby to multiple periods of withdrawal, which can be harmful for placenta function.

Other direct physical risks include but are not limited to the following:

  • Neonatal abstinence syndrome
  • Stunted growth
  • Preterm labor
  • Fetal convulsions
  • Fetal death

Other indirect fetal risks include:

  • Increased risk for maternal infection (I.e.: HIV, HBV, HCV)
  • Malnutrition and poor prenatal care
  • Dangers drug-seeking behavior (I.e.: violence, incarceration) 

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome or NAS occurs when an infant becomes dependent on opioids or other drugs used by the mother during pregnancy. The infant can experience symptoms of withdrawal that can include tremors, diarrhea, fever, irritability, seizures, difficulty feeding, and death.

NAS has increased nearly fivefold nationally between 2000 to 2012, which is in correlation with rising rates of opioid use disorder overall.

Medically Driven Solutions

Evidence-Based Treatment

Buprenorphine and methadone have been proven as safe and effective methods of treatment for opioid use disorder for pregnancy. While NAS may still occur for babies born by mothers receiving these medications, it has shown less severe than in the complete absence of treatment. Research does not support reducing medication dose to prevent NAS, as it may lead to increased illicit drug use by the mother. Which will result in greater risk to the fetus.

Methadone vs. Buprenorphine

While recent studies have shown an associated higher treatment retention rate with methadone, buprenorphine has shown better results for the fetus. Those findings are listed below:

  • 10 percent lower incidence of NAS
  • Decreased neonatal treatment time by 8.46 days
  • Less morphine needed for NAS treatment by 3.6mg

Patients should work closely with their doctor to determine the best form of treatment for them.

Breastfeeding During Treatment

While breastfeeding statistics are typically low with mothers suffering from opioid use disorder, studies have shown that breastfeeding can decrease the length of hospital stay as well as lowering the need for morphine treatment for infants. Unless there are specific medical concerns such as maternal HIV infections, mothers are encouraged to breastfeed and swaddle newborns to ease infant NAS symptoms and improve bonding.

Methadone and Buprenorphine Can Effectively Treat Opioid Use Disorder During Pregnancy

Since the 1970s methadone has been used to treat pregnant women with opioid use disorder and has been recognized as the standard for care by 1998. However, studies have shown that buprenorphine is a feasible alternative treatment. The American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine support both methadone and buprenorphine treatment as the best treatment options for pregnant mothers with opioid use disorder.

Benefits of Treatment During Pregnancy

Methadone or buprenorphine treatment improves infant outcomes by the following:

  • Stabilizing fetal levels of opioid, therefore, reducing repeated prenatal withdrawal
  • Providing mothers with infectious diseases (I.e.: HIV, HBV, HCV) access to treatment, therefore, reducing the likelihood of transmission of disease to the unborn baby
  • Providing more stabilized opportunities to better prenatal care improving the long-term health outcomes for both mother and baby

When compared to mothers who were left untreated, women who are treated with methadone or buprenorphine generally have infants with:

  • Lower risk of NAS
  • Less severe NAS
  • Shorter treatment time
  • Higher gestational age, weight, and head circumference at birth

Solutions Driven Science

Increasing Treatment Prescribing

NIDA-funded studies are evaluating the key barriers and facilitators to prescribing methadone and buprenorphine for pregnant mothers suffering from opioid use disorder. Current projects include:

  • Validating reliable screen tools to identify pregnant women in need of treatment
  • Analyzing infant outcomes to inform medication selection for mother suffering from opioid use disorder
  • Evaluating behavioral interventions for misuse of opioids during pregnancy 

Improving Treatment Strategies

Treatment with either methadone or buprenorphine does have some risk for infants developing NAS. Dividing dosing with methadone such as taking smaller doses more often – reduces fetal exposure to potential withdrawal periods between doses. Mothers treated with divided doses often deliver babies with a lower NAS severity. Currently, the study is also examining buprenorphine during pregnancy and how to improve the dosing regimens.

Improving Engagement in Treatment

  • The stigma and bias often shown from healthcare providers can result in under-reporting of drug use and insufficient medication dosing which often leads to the delay or infectiveness of treatment
  • Eighteen states classify maternal drug use as child abuse and three states consider it as reason for involuntary hospitalization, therefore, decreasing the likelihood of women seeking treating.
  • Studies have shown to the contrary that women who are allowed to stay with their children during treatment are more likely to successfully undergo treatment for the duration of the pregnancy and to maintain abstinence afterward.

Supporting Access to Treatment

Health insurance providers that cover treatment for substance use disorder are required to provide coverage equivalent to what is provided for other health conditions. Dr. Buscema, has made it the mission of Addiction Alternatives to help pregnant women suffering from opioid use disorder to not only provide treatment but to also find access to gynecologists and obstetricians in the area inclined to help these mothers during and after pregnancy.

Where Can I Get More Information?

If you or someone you care about is pregnant and has opioid use disorder:

Call Addiction Alternatives at (772) 618-0505

Visit our site at www.addictionalternatives.org

Statistical information provided by:

https://www.drugabuse.gov/publications/treating-opioid-use-disorder-during-pregnancy/treating-opioid-use-disorder-during-pregnancy

https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387

https://archives.drugabuse.gov/news-events/nida-notes/2012/07/buprenorphine-during-pregnancy-reduces-neonate-distress

https://www.hindawi.com/journals/jp/2014/906723/

https://www.jognn.org/article/S0884-2175(16)30208-8/pdf