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Experts outline priorities for addressing opioid use in women who are pregnant

Leaders of NIH, CDC, the American Congress of Obstetricians and Gynecologists, the AAP, the Society for Maternal-Fetal Medicine and the March of Dimes sponsored a workshop that identified critical areas where research is needed and goals need to be set to address opioid use disorder in pregnant women.

The session, an executive summary of which can be found in Obstetrics and Gynecology, also discussed the care of infants born to these women.

“We brought these people together to really understand what we need to do, in terms of research, to be able to combat this crisis,” Uma M. Reddy, MD, of NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development Pregnancy and Perinatology Branch, said in a video statement.

According to Reddy, 32% of women deliver by cesarean section.

“These women are typically prescribed short-term narcotics for the pain, and 93% of women have leftover pain medication. They are not sure how to dispose of it, so it’s left [lying] around,” Reddy said in the video statement. “What was really shocking is that one out of every 300 women after a C-section become persistent opioid users.”

A recent review of the National Surveys on Drug Use and Health from 2007 to 2012 found that an annual average of about 21,000 pregnant women aged 15 to 44 misused opioids in the past month. This report also showed that among pregnant women, past month opioid misuse was more common among those aged 15 to 17 and 18 to 25 than among those aged 26 to 34, and more common among those living below the federal poverty level than among those living at or above the federal poverty level. Other research published in Pediatrics suggested an estimated 14% to 22% of women received an opioid prescription during pregnancy and that from 1998 to 2011, the prevalence of opioid abuse or dependence among pregnant during hospitalizations for delivery went up 127%.

Reddy said one of the priorities discussed at the meeting was how to best screen and treat women who are pregnant and using opioids.

“We don’t screen women, we don’t even ask them [if they are using opioids],” she said in the video. “But everybody at the workshop agreed that we should ask women, in a nonjudgmental way, and explain to them that we ask all women about this, just like with alcohol, cigarettes. It’s a routine part of prenatal care.”

According to the executive summary, there is disagreement between professional societies with regard to screening for substance use in pregnancy. While the American Congress of Obstetricians and Gynecologists recommends screening all women for substance use before and during early pregnancy and providing intervention when needed, the U.S. Preventive Services Task Force has concluded that there is insufficient evidence to evaluate the benefits and harms of screening for illicit drug use in clinical populations including pregnant women.

Other priorities identified at the meeting:

•comprehending the problems that can accompany opioid use disorder in pregnancy, such as use of other substances, poor nutrition, mental illness and exposure to violence;

•addressing pain management for women with opioid use disorder during labor and on special interventions after delivery;

•reducing unnecessary opioid use in healthy women after delivery; and

•needing better methods to screen for and identify neonatal abstinence syndrome.

Meeting attendees also discussed the dearth of research on long-term outcomes for children who were exposed to opioids in the womb, according to Reddy.

“Every 30 minutes there is a baby being born to a woman who has used opioids and is having neonatal abstinence syndrome,” she said in the video.

Currently, researchers know that babies with neonatal abstinence syndrome experience tremors, incessant crying and irritability, as well as problems sleeping, feeding and breathing, but Reddy said “very little data” exists on the impact of babies exposed specifically to opioids in utero.

“A pregnant woman and her newborn encounter different medical teams at every stage —prenatal visits, labor and delivery, and postpartum care. Specialists need to work together throughout the process to optimize care and long-term outcomes for families,” Reddy said in the release. – by Janel Miller

References:

Lind JN, et al. Pediatrics. 2017;doi: 10.1542/peds.2016.4131.

Smith K, Lipari RN. Women of childbearing age and opioids. The CBHSQ Report: January 17, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.

Disclosure: Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.