Opioids prescribed in pregnancy increase risk of neonatal opioid withdrawal syndrome: JAMA

USA: A new study conducted by Daina B. Esposito and team found that opioids with lengthy half-lives and potent agonists in utero are associated with an increased incidence of severe neonatal opioid withdrawal syndrome (NOWS). The findings of this study were published in the Journal of the American Medical Association.

Even though they are linked to newborn opioid withdrawal syndrome, opioids are often taken during pregnancy. Despite the pharmacological and pharmacokinetic variability across opioid medicines, only the class-wide result has been evaluated in the majority of investigations investigating the negative effects of opioid usage for pain. This study compared the risk of NOWS among popular opioid drug classes when used as monotherapy in the final three months of pregnancy.

This cohort research examined administrative claims data from mothers and babies covered by Medicaid in 46 states and the District of Columbia between January 1, 2000, and December 31, 2014. Participants included eligible live-born neonates and moms who had two or more opioid prescriptions filled within 90 days after birth. From February 2020 to March 2021, data were examined. The agonist potency (strong vs. weak) and opioid active component half-life (medium vs. long vs. short) of several opioid drug kinds were compared.

The key highlights of this study were:

1. The cohort included 48 202 live births from pregnancies exposed to opioids.

2. 1069 newborns overall (2.2%) and 559 (1.2%) had severe NOWS. Contrary to 25 710 pregnancies exposed to hydrocodone, opioid exposure during pregnancy comprised 16 202 pregnancies exposed to codeine, 4540 to oxycodone, 1244 to tramadol, 260 to methadone (dispensed for pain), 90 to hydromorphone, and 63 to morphine.

3. The demographics of opioids varied, with tramadol, oxycodone, methadone, hydromorphone, and morphine being more frequently prescribed to mothers who were older (>35 years).

4. In comparison to hydrocodone, codeine had a lower adjusted RR of NOWS, whereas tramadol had a comparable adjusted RR and oxycodone, morphine, methadone, and hydromorphone had adjusted RRs that were two to three times higher.

5. Strong agonists were linked to a larger risk of NOWS than weak agonists, while opioids with long half-lives were linked to a higher risk compared to those with short half-lives.

6. Results from sensitivity and subgroup analysis were consistent.

Although every patient's needs for pain management are unique, knowing the risks of NOWS associated with particular opioids may assist prescribers in deciding which opioid to use to treat pain in the late stages of pregnancy.

Reference: 

Esposito, D. B., Huybrechts, K. F., Werler, M. M., Straub, L., Hernández-Díaz, S., Mogun, H., & Bateman, B. T. (2022). Characteristics of Prescription Opioid Analgesics in Pregnancy and Risk of Neonatal Opioid Withdrawal Syndrome in Newborns. In JAMA Network Open (Vol. 5, Issue 8, p. e2228588). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.28588