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2020 Oct

Opioid Use in Pregnancy

Talk to your health care provider if you take opioids. Your baby’s health—and yours—depend on it.

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as potential treatment options for opioid use disorder.

Opioids are a class of drugs used to reduce pain. Common prescription opioids include codeine, oxycodone, hydrocodone, and morphine. Fentanyl is a prescription synthetic opioid pain reliever. It can also be made illegally. Heroin is an illegal opioid. Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to treat opioid use disorders. Methadone and buprenorphine are first-line therapy options for pregnant women with opioid use disorder.

Opioid exposure during pregnancy has been linked to some adverse health effects for both mothers and their babies. As an example, for mothers, opioid use disorder has been linked to maternal death. For babies, opioid use disorder or long-term opioid use has been linked to poor fetal growth, preterm birth, stillbirth, specific birth defects, and neonatal abstinence syndrome. The effects of prenatal opioid exposure on children over time are largely unknown.

In some cases—such as the treatment of opioid use disorder during pregnancy—continued use of opioid medications as prescribed outweighs the risks. Women should consult their physician before stopping or changing any prescribed medication.

Neonatal abstinence syndrome (NAS) is a group of conditions that can occur when newborns withdraw from certain substances, including opioids that they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Signs of withdrawal usually begin within 72 hours after birth and may include the following:

  • Tremors
  •  Irritability, including excessive or high-pitched crying
  • Sleep problems
  • Hyperactive reflexes
  • Seizures
  • Yawning, stuffy nose, or sneezing
  • Poor feeding and sucking
  • Vomiting
  • Loose stools and dehydration
  • Increased sweating

The signs a newborn might experience, and how severe the signs will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to other substances (e.g., alcohol, tobacco, other medications) before birth.

If a woman is pregnant or planning to become pregnant, the first thing she should do is talk to a healthcare provider. Creating a treatment plan for opioid use disorder before pregnancy can help a woman increase her chances of a healthy pregnancy. Quickly stopping opioids during pregnancy is not recommended, as it can have serious consequences, including preterm labor, fetal distress, or miscarriage. Current clinical recommendations for pregnant women with opioid use disorder include medication-assisted treatment rather than supervised withdrawal, due to a higher likelihood of better outcomes and a reduced risk of relapse.

Support for women with opioid use disorder is critical in the postpartum period, which is a time of many adjustments, including sleep deprivation and the demands of caring for a newborn. As recommended, women with opioid use disorder should continue MAT as prescribed in the postpartum period. Healthcare providers should monitor women for potential signs or symptoms of sedation, in order to modify dosage if appropriate.

Discontinuation of MAT for opioid use disorder should generally be avoided in the immediate postpartum period. However, it may be considered at a later time if the mother is stable and the mother and child are well-bonded and have a safe and stable home and social environment. Pharmacotherapy for opioid use disorder should be discontinued only with medical supervision and only when it is in the best interest of the mother and infant.

Melissa Waddell, WHNP, is a nurse practitioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. For information, call 757-463-1234 or visit www.atlanticobgyn.com.

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