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Prenatal opioid exposure is a growing public health crisis, yet there has been limited data concerning the effects of opioids on developing children. A recent study presented at the Radiological Society of North America (RSNA) found that prenatal exposure to opioids may alter connectivity in the area of the brain that regulates emotions.

About the Study

pregnant woman holding her stomachTo reach these findings, a team of obstetricians, neonatologists, psychologists and imaging scientists examined the brain activity and blood flow of 16 infants, eight of whom were exposed to opioids in utero. Using resting state functional MRI (fMRI), the team was able to observe the connectivity among the infants’ resting state networks while they slept.

The researchers looked at the left and right regions of the amygdala, the area used to regulate anger, sadness, fear and aggression. In the process, they discovered that connectivity to the rest of the brain was markedly different between the groups.

These results may help in understanding the long-term exposure risks of opioids on developing brains. Currently, many children exposed to opioids while in utero experience drug withdrawal and neonatal abstinence syndrome (NAS), which require hospitalization for treatment.

Opioid Use During Pregnancy

There are several reasons a woman may use opioids during pregnancy, including:

  • A doctor prescribed the medication
  • She is misusing prescription opioids
  • She has started using illegal opioids
  • She’s currently going through a withdrawal treatment for opioid-use disorder

The Centers for Disease Control and Prevention (CDC) estimates that one-third of all reproductive-age women filled an opioid prescription from 2008 to 2012. Although many instances may be related to a doctor’s recommendations, the number of women with opioid-use disorder increased four times from 1999 to 2014.

In all cases, prenatal opioid use has negative effects on both the mother and child, including:

  • Poor fetal growth
  • Preterm births
  • Maternal death
  • Stillbirths
  • Birth defects
  • NAS
  • Longer hospital stays after birth
  • Re-hospitalization within 30 days of giving birth

Unfortunately, reducing these effects is not as straightforward as stopping opioids. Expectant mothers have been known to experience preterm labor or miscarriage, while the developing baby could experience a high level of fetal distress. As such, a doctor may recommend a patient continue with a particular opioid treatment program to reduce these outcomes. If the patient is already living with opioid-use disorder, she may be steered to medication-assisted treatment (MAT).

MAT plans combine medication, counseling and behavioral therapies to decrease a patient’s dependency on a substance. For an expectant mother living with opioid-use disorder, a doctor may have her take methadone or buprenorphine, closely monitoring her condition before and after delivery. In the case a patient undergoing MAT is pregnant, the treatment plan may further involve an OB-GYN and addiction specialist, in addition to her primary care provider.

Avoidance of Medication-Assisted Treatment

Some women may avoid MAT and similar treatment programs while pregnant, out of fear they will be criminalized for drug use and have their children taken away. According to a recent study by the RAND Corporation, researchers found that in states where opioid use during pregnancy leads to criminal charges, the percentage of children born with opioid withdrawal symptoms is higher. Looking at cases from 2000 through 2015, researchers found that in states with such measures, 57 out of 10,000 children born had opioid withdrawal symptoms, versus 46 out of 10,000 births in states where such measures are not in place.

Currently, 23 states and the District of Columbia classify prenatal opioid use as child abuse under civil child welfare laws and 25 states plus the District of Columbia require health care professionals to report suspected prenatal drug use. As such, some pregnant women using opioids intentionally avoid treatment programs that could help them gradually reduce use.

What is Neonatal Abstinence Syndrome (NAS)?

As one serious consequence of prenatal opioid exposure, NAS can occur when children experience withdrawal symptoms after birth and often kicks in 48 to 72 hours after the child arrives. The condition may also be called neonatal opioid withdrawal syndrome (NOWS) if withdrawal occurs within the child’s first 28 days. In all cases, an infant shows signs of:

  • Trembling
  • Irritability
  • High-pitched crying
  • Sleep issues
  • Extremely reactive reflexes
  • Seizures
  • Sneezing and nasal congestion
  • Difficulty feeding and sucking
  • Vomiting
  • Dehydration
  • Loose stools
  • Excessive sweating

The symptoms and severity of the condition depend on the type and amount of opioids to which the child was exposed, when the mother last used, if the child was born before the scheduled delivery date and the number of drugs the mother used. In all cases, NAS frequently involves a lengthy hospital stay and for most children born with the condition, the mother is using Medicaid over private insurance. According to figures from the CDC, NAS costs hospitals over $500 million annually.

The long-term effects of NAS are still coming to light. Based on results from a recent study, children born with NAS have a higher likelihood of experiencing developmental delays and language impairments.

Although the number of opioid-related overdoses has started climbing down after reaching a high in 2017, the crisis goes back to the marketing practices of drug companies in the 1990s. As towns shoulder the costs related to overdose treatment and social services, communities have started holding these manufacturers responsible for their extreme negligence.