The opioid crisis has become far more serious than some of the other epidemics the country has faced. This collection of timely AAP journal articles, blog posts, and policy explores the risks and possible solutions.
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Prescription Opioid Epidemic and Infant Outcomes
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Published:March 2018
Stephen W. Patrick, MD, MPH, MS, Judith Dudley, BS, Peter R. Martin, MD, MSc, Frank E. Harrell, PhD, Michael D. Warren, MD, MPH, Katherine E. Hartmann, MD, PhD, E. Wesley Ely, MD, MPH, Carlos G. Grijalva, MD, MPH, William O. Cooper, MD, MPH, 2018. "Prescription Opioid Epidemic and Infant Outcomes", Opioid Addiction, American Academy of Pediatrics
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Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS).
We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.
Of 112 029 pregnant women, 31 354 (28%) filled ≥1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67–2.60]) were associated with greater risk of developing NAS.
Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.
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