Neonatal Abstinence Syndrome Increases with Opioid Epidemic

Concomitant use of opioids and psychotropic drugs during pregnancy increases the risk of neonatal abstinence syndrome.

Each day in the United States, numerous infants are born with neonatal abstinence syndrome, which is caused by exposure to prescription or illicit drugs during pregnancy. The symptoms of neonatal abstinence syndrome includes difficulty sleeping or seizures.

The use of opioids and other psychotropic drugs during pregnancy are known to cause drug withdrawal in infants. Psychotropic drugs are increasingly being prescribed to pregnant patients who are also taking opioids. The opioid epidemic may also be increasing the rate of infants exposed to prescription and illicit opioids.

In a new BMJ study, the authors aimed to determine how exposure to psychotropic drugs and opioids in utero play a role in neonatal abstinence syndrome.

Included in the study were data from more than 200,000 pregnant Medicaid enrollees who were prescribed opioids. The authors examined whether the risk of neonatal abstinence syndrome was higher among infants whose mothers were prescribed psychotropic drugs in addition to opioids.

After accounting for various confounding factors, the risk of the syndrome was significantly higher among infants whose mothers were taking both drugs compared with infants exposed to opioids alone, according to the study.

The authors found that the absolute risk of withdrawal among infants exposed to opioids alone was only 1%, while exposure to psychotropic drugs increased the risk. The authors reported that the highest risk was among women exposed to gabapentin and opioids, at 11.4%, according to the study.

However, there was no significant increase in risk when adding atypical antipsychotics or Z drugs to opioid use in mothers, the authors reported.

Overall, the severity of the withdrawal was observed to increase with concomitant use of opioids and psychotropic drugs, according to the study.

Although this was an observational study, the results remained similar after additional analyses were conducted, according to the authors.

"In conclusion, our findings suggest that among women using prescription opioids during pregnancy, co-exposure to antidepressants, benzodiazepines, and gabapentin might be associated with an increased risk of drug withdrawal in the neonate," the authors wrote.

The authors warn physicians to use caution when prescribing these drugs to patients who are pregnant and those with suspected illicit opioid use, according to the study.

“Our findings also imply that it will be important for neonatologists and pediatricians to rethink treatment protocols for infants born to women who were prescribed multiple drugs during their pregnancy,” the study concluded.