Opioid use during pregnancy can have significant implications for both the mother and the developing fetus.
Opioids are a class of drugs that include prescription painkillers (e.g., oxycodone, hydrocodone) and illicit substances like heroin. Opioid use during pregnancy is associated with an increased risk of complications, including an elevated risk of preterm birth, low birth weight, intrauterine growth restriction, and stillbirth. Opioids are substances that can cross the placenta, exposing the developing fetus to the drugs. This exposure can potentially lead to various adverse effects on fetal development, including an increased risk of birth defects. One of the most well-known consequences of maternal opioid use during pregnancy is the risk of neonatal abstinence syndrome (NAS). NAS occurs when the newborn experiences withdrawal symptoms after birth due to exposure to opioids in the womb. Maternal opioid use during pregnancy can also have long-term effects on the child's development. These effects may include cognitive and behavioral problems, as well as an increased risk of substance use disorders later in life.
Opioid usage is common among pregnant women and is on the rise. [1] Opioid drugs are used for various reasons during pregnancy, with pain being a frequent issue. Conditions like pelvic and lower back pain, occurring in around 68 to 72% of pregnancies, are commonly treated with these medications. [1] [2] [3] Moreover, other sources of pain like muscle aches, migraines, and joint pain are commonly reported during pregnancy. [1] [4]
However, when it comes to chronic pain, guidelines from the American Pain Society recommend discussing the advantages and disadvantages of chronic opioid therapy with women and, if possible, limiting or avoiding opioid use during pregnancy due to potential risks to the fetus. [1] [5] Even though there is evidence suggesting harmful impacts on fetal development caused by prescription opioids, [6] [7] [8] [9] research conducted in both Europe and the United States consistently shows elevated levels of prescription opioid use during pregnancy, whether it's for medical reasons or due to opioid dependency. [1] It's important to note that prescription opioids encompass a range of medications, and the potential effects on the fetus may differ between different medications within the same drug class. [1]
Opioids can cross both the placental and blood-brain barriers, which poses risks to fetuses and newborns exposed to these drugs before birth. This exposure to opioids during pregnancy can lead to potential obstetric complications, including spontaneous abortion, abruption of the placenta, pre-eclampsia, prelabor rupture of membranes, and fetal death. [10] [11] There are also adverse outcomes in newborns associated with maternal opioid use during pregnancy, such as sudden infant death syndrome, being smaller than expected for their gestational age, preterm birth, lower birth weight, and reduced head size. [10] [12] Neonatal abstinence syndrome is a commonly observed issue in newborns who were exposed to opioids before birth.
The use of opioids in the early stages of pregnancy is associated with an elevated risk of congenital anomalies. Specifically, there is a two-fold increased likelihood of certain birth defects, including congenital heart defects, gastroschisis, and neural tube defects. [10] [9] [6] The risk of preterm birth and neonatal complications is reduced to some extent when dextropropoxyphene or codeine is used in comparison to other opioid analgesics. [13] [14]
The potential impact on the neurodevelopment of infants exposed to opioids before birth is another significant concern. A recent meta-analysis revealed noteworthy deficiencies in cognitive, psychomotor, and behavioral abilities in infants and preschool-aged children who had experienced chronic intrauterine opioid exposure. [10] Children who experienced neonatal abstinence syndrome were notably more prone to hospitalizations due to cognitive impairments, communication, speech, or language disorders, autism spectrum disorder, and behavioral problems, particularly those concerning emotional control. [15] [16]
Neonatal abstinence syndrome occurs when newborns go through withdrawal from opiates and is linked to dysfunction in the central and autonomic nervous systems, the respiratory system, and the gastrointestinal tract. [13] Additionally, there is an elevated risk of neonatal abstinence syndrome associated with the medical use of certain opioid analgesics, such as tramadol, codeine, and propoxyphene. [13]
Pregnant women with opioid use disorder have treatment options including methadone, naltrexone, or buprenorphine to decrease opioid usage and enhance treatment adherence. [17] [18] Current guidelines suggest that methadone and buprenorphine are equally viable choices. Nevertheless, recent research suggests that buprenorphine may offer certain advantages over methadone. [19]
Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is necessary to conclusively diagnose the majority of genetic disorders, with amniocentesis being the gold-standard procedure after 15 weeks' gestation.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.
Buprenorphine, sold under the brand name Subutex among others, is an opioid used to treat opioid use disorder, acute pain, and chronic pain. It can be used under the tongue (sublingual), in the cheek (buccal), by injection, as a skin patch (transdermal), or as an implant. For opioid use disorder, it is typically started when withdrawal symptoms have begun and for the first two days of treatment under direct observation of a health-care provider.
Tocolytics are medications used to suppress premature labor. Preterm birth accounts for 70% of neonatal deaths. Therefore, tocolytic therapy is provided when delivery would result in premature birth, postponing delivery long enough for the administration of glucocorticoids, which accelerate fetal lung maturity but may require one to two days to take effect.
Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Prenatal development includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.
Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.
Antenatal steroids, also known as antenatal corticosteroids, are medications administered to pregnant women expecting a preterm birth. When administered, these steroids accelerate the maturation of the fetus' lungs, which reduces the likelihood of infant respiratory distress syndrome and infant mortality. The effectiveness of this corticosteroid treatment on humans was first demonstrated in 1972 by Sir Graham Liggins and Ross Howie, during a randomized control trial using betamethasone.
Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes, usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert panel recommended use of the term "triple I" to address the heterogeneity of this disorder. The term triple I refers to intrauterine infection or inflammation or both and is defined by strict diagnostic criteria, but this terminology has not been commonly adopted although the criteria are used.
Maternal–fetal medicine (MFM), also known as perinatology, is a branch of medicine that focuses on managing health concerns of the mother and fetus prior to, during, and shortly after pregnancy.
Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. Non-essential drugs and medications should be avoided while pregnant. Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects. Even small amounts of alcohol, tobacco, and marijuana have not been proven to be safe when taken while pregnant. In some cases, for example, if the mother has epilepsy or diabetes, the risk of stopping a medication may be worse than risks associated with taking the medication while pregnant. The mother's healthcare professional will help make these decisions about the safest way to protect the health of both the mother and unborn child. In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.
Neonatal withdrawal or neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) is a withdrawal syndrome of infants after birth caused by in utero exposure to drugs of dependence, most commonly opioids. Common signs and symptoms include tremors, irritability, vomiting, diarrhea, and fever. NAS is primarily diagnosed with a detailed medication history and scoring systems. First-line treatment should begin with non-medication interventions to support neonate growth, though medication interventions may be used in certain situations.
A high-risk pregnancy is one where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.
A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.
Hypertensive disease of pregnancy, also known as maternal hypertensive disorder, is a group of high blood pressure disorders that include preeclampsia, preeclampsia superimposed on chronic hypertension, gestational hypertension, and chronic hypertension.
Alcohol use in pregnancy includes use of alcohol at any time during gestation, including the time before a mother-to-be is aware that she is pregnant. Alcohol use at some point during pregnancy is common and appears to be rising in prevalence in the United States.
Hendrée E. Jones is a researcher on women's substance abuse disorders and its impact on children. She is a professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, and adjunct professor in the University of North Carolina College of Arts & Sciences Department of Psychology and Neuroscience. Jones is the executive director of the UNC Horizons Program, which is a comprehensive drug treatment program for mothers and their drug-exposed children. She is a consultant for the Substance Abuse and Mental Health Services Administration, the United Nations, and the World Health Organization.
Opioid withdrawal is a set of symptoms arising from the sudden withdrawal or reduction of opioids where previous usage has been heavy and prolonged. Signs and symptoms of withdrawal can include drug craving, anxiety, restless legs, nausea, vomiting, diarrhea, sweating, and an increased heart rate. Opioid use triggers a rapid adaptation in cellular signalling pathways that means, when rapidly withdrawn, there can be adverse physiological effects. All opioids, both recreational drugs and medications, when reduced or stopped, can lead to opioid withdrawal symptoms. When withdrawal symptoms are due to recreational opioid use, the term opioid use disorder is used, whereas when due to prescribed medications, the term prescription opioid use disorder is used. Opioid withdrawal can be helped by the use of opioid replacement therapy, and symptoms may be relieved by the use of medications including lofexidine and clonidine.
Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with Opioid use disorder (OUD). The benefits of this treatment include a more manageable withdrawal experience, cognitive improvement, and lower HIV transmission. The length of OAT varies from one individual to another based on their physiology, environmental surroundings, and quality of life.
Pregnancy in a rudimentary horn of the uterus is a very rare type of ectopic pregnancy. This type of pregnancy can be life-threatening, as the rudimentary horn is not meant to sustain a pregnancy and is at risk of rupturing.
