In the US, about every 25 minutes an infant is born with signs of drug withdrawal.
Prescriptions for opioid analgesics in the US have increased more than threefold over the past two decades, and this rise also extends to prescriptions to pregnant women. About 14-22% of pregnancies in the US are complicated by exposure to prescription opioid medications.
A strong increase in the prescription of opioids has also been observed in most European countries (such as Germany, Italy, Spain, Scandinavia, UK, the Netherlands) and Australia, though the number of prescriptions and defined daily doses remains much lower than in the US and Canada Data from a population based registry in Norway showed that 6% of pregnant women filled at least one opioid prescription in 2004-06.
Neonatal abstinence syndrome (NAS) is a well recognized complication of intrauterine exposure to opioid analgesics, with manifestations ranging from difficulties with feeding and sleeping to more severe complications including impaired thermoregulation, seizures, failure to thrive, and respiratory distress. From 2000 to 2012, hospital charges for this syndrome increased from about $190m (about £150m; €170m) to $1.5bn.
2017 Study Abstract
Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study, BMJ 2017;358:j3326, 02 August 2017.
Image credit @bmj_latest.
To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.
Observational cohort study.
Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).
201 275 pregnant women with public insurance who were exposed to opioids around the time of delivery and their liveborn infants.
In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids.
Main outcome measure
Diagnosis of neonatal drug withdrawal in infants exposed in utero to opioids and psychotropic medications compared with opioids alone.
The absolute risk for neonatal drug withdrawal ranged from 1.0% in infants exposed in utero to prescription opioids alone to 11.4% for those exposed to opioids co-prescribed with gabapentin. Among neonates exposed in utero to prescription opioids, the relative risk adjusted for propensity score was 1.34 (95% confidence interval 1.22 to 1.47) with concomitant exposure to antidepressants, 1.49 (1.35 to 1.63) with benzodiazepines, 1.61 (1.26 to 2.06) with gabapentin, 1.20 (0.95 to 1.51) with antipsychotics, and 1.01 (0.88 to 1.15) with Z drugs. In utero exposure to two or more psychotropic medications along with opioids was associated with a twofold increased risk of withdrawal (2.05, 1.77 to 2.37). The severity of the withdrawal seemed increased in neonates exposed to both opioids and psychotropic medications compared with opioids alone.
During pregnancy, the use of psychotropic medications in addition to prescription opioids is common, despite a lack of safety data. The current findings suggest that these drugs could further increase the risk and severity of neonatal drug withdrawal.