Opioid epidemic impacting infants

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Use of prescription opioids and psychotropic meds during pregnancy increases risk of drug withdrawal in newborns, US study finds

Researchers from Brigham and Women’s Hospital and Harvard Medical School have analysed data from more than 200,000 pregnant women who had been exposed to opioids.

In addition, they looked at whether these same women had also filled a script within the same time window for psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs).

The study, published in the BMJ, found that the severity of the withdrawal seemed to increase in infants exposed to both opioids and psychotropic medications, compared with opioids alone.

Drug withdrawal in infants (also known as neonatal abstinence syndrome) can lead to difficulties with feeding and sleeping, irritability, breathing problems and seizures.

Summary of findings:

  • Infants were more likely to experience drug withdrawal if exposed in utero to both opioids and psychotropic medicines, compared with opioids alone.
  • Absolute risk for neonatal drug withdrawal ranged from 1.0% in infants exposed to opioids alone, to 11.4% for those exposed to opioids co-prescribed with gabapentin.
  • Among infants exposed to prescription opioids, relative risk was 1.34 with concomitant exposure to antidepressants, 1.49 with benzodiazepines, 1.61 with gabapentin, 1.20 with antipsychotics, and 1.01 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).

“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,” say the authors.

“About 14-22% of pregnancies in the US are complicated by exposure to prescription opioid medications.”

The findings are particularly concerning considering gabapentin is being prescribed more often for control of pain, say the authors.

“Because pain and mental health conditions often occur together, co-exposure will be unavoidable in many instances.

“In those cases, our findings might be helpful in risk stratification for exposed infants.”

In an accompanying editorial, paediatrics professors Stephen Patrick, William Cooper and Matthew Davis add that most of all medications in use today lack information to determine their safe use during pregnancy.

“These findings suggest a clear need for a comprehensive, evidence informed strategy regarding opioid use in pregnancy,” they say.

BMJ 2017; online 2 August

Editorial BMJ 2017; online 2 August

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