Two Studies Highlight the Negative-and Lasting-Impact of Perinatal Opioids on Infants and Mothers
Two recent studies published by JAMA Network Open in July 2019 show evidence that opioids prescribed in the perinatal setting could produce lasting damage in infants and children, and lead to persistent opioid use in mothers.
In the first study, the authors attempted to assess the effects of prenatal opioid exposure (POE) on later cognitive and motor outcomes, and the authors reviewed 26 peer-reviewed cohort studies comparing 1455 children with POE and 2982 nonexposed children, across 3 age groups. (See Yeoh SL, Eastwood J, Wright IM, et al. Cognitive and motor outcomes of children with prenatal opioid exposure: a systematic review and meta-analysis. JAMA Netw Open 2019; 2(7):e197025.)
Children with POE scored lower on standardized tests in 2 age groups: birth up to age 2 years, and age 3 to 6 years. The difference was not significant in children in the 7 to 18 years' age group.
The authors noted that public expenditure on hospital care for newborns with neonatal abstinence syndrome that affects up to 90% of babies with POE exceeds $1 billion per year.
For more detailed information on this study, see page 9 (ICYMI: In Case You Missed It).
Opioids Prescribed After Vaginal or Cesarean Delivery
In the second study, the authors investigated the rates of new persistent opioid use among women who receive an opioid prescription after undergoing vaginal or cesarean delivery.
The US national cohort study included 308,226 deliveries in which women received a peripartum opioid prescription. Of the women included in the study who had a vaginal delivery, 1.7% had new persistent use of opioids. Of those who had a cesarean delivery, 2.2% had persistent use of opioids after delivery. Prescription size and filling a prescription before delivery were associated with new persistent opioid use. (See Peahl AF, Dalton VK, Montgomery JR, et al. Rates of new persistent opioid use after vaginal or cesarean birth among US women [published online ahead of print July 26, 2019]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.7863.)
Although the percentage may seem small, because of the high number of births in the United States, even 2% is a significant number.
The authors wrote that their results suggest that maternity care clinicians can potentially decrease new persistent opioid use among women after either vaginal or cesarean delivery through judicious opioid prescribing.
On the bright side, the results of the study suggested that opioid prescribing and new persistent use after vaginal delivery or cesarean delivery have decreased since 2008.
Still, the authors write that judicious opioid prescribing and preoperative risk screening may be opportunities to decrease new persistent opioid use after childbirth.
They chose this population to study because pregnancy and delivery are often the first exposure women have to prescription opioids. They found that the biggest factor associated with increased odds of developing persistent opioid use is the first fill of a prescription, rather than the type of delivery.