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Prepregnancy surgery significantly increases risk for neonatal withdrawal
Prepregnancy surgery is associated with an increased risk for neonatal abstinence syndrome in later pregnancies, according to study results published in the Canadian Medical Association Journal.
“Many women are first introduced to opioids after surgery through prescriptions for postoperative pain control, but the potential link with neonatal abstinence syndrome in future pregnancies has never been assessed,” Nathalie Auger, MD, MSc, of the University of Montreal Hospital Research Centre, and the School of Public Health at the Institut national de santé publique du Québec, and colleagues wrote.
“Owing to the high frequency of surgical procedures at young ages, women who undergo surgery may be more vulnerable to prolonged opioid use during their reproductive years,” they continued.
To determine if prepregnancy surgery led to neonatal abstinence syndrome in future offspring, Auger and colleagues conducted a retrospective cohort study of births between 1989 to 2016 in Quebec, Canada. They used registry data that included discharge abstracts from all hospital admissions in Quebec to identify births within the study period. The data were also used to identify information on prepregnancy surgeries, including severity of surgery, surgical specialty and patient age at surgery.
A total of 2,346 of the 2,182,365 neonates included in the study had neonatal abstinence syndrome, making the overall prevalence 10.7 per 10,000 births (95% CI, 10.3-11.2).
Among births with neonatal abstinence syndrome, 1,052 included mothers with prepregnancy surgery (14.9 per 10,000 births).
Compared to those who did not have surgery, those with prepregnancy surgery were at 1.63 times the risk for neonatal abstinence syndrome (RR = 1.63;95% CI, 1.49-1.78).
Participants with more than three prepregnancy surgeries were at an even greater risk for having infants with neonatal abstinence syndrome (RR = 2.34; 95% CI, 2.07-2.63), along with those who were aged less than 15 years at the time of the first surgery (one surgery: RR = 2.08; 95% CI, 1.71-2.54; two or more surgeries: RR = 2.79, 95% CI, 2.32-3.37).
Researchers noted that nearly all surgical specialties were associated with increased risk for neonatal abstinence syndrome, with the highest risk tied to cardiothoracic surgery (RR = 4.45; 95% CI, 2.87-6.91), neurosurgery (RR = 3; 95% CI, 1.56-5.77) and urologic surgery (RR = 3.03; 95% CI, 2.16-4.26).
“Prescription opioids for postsurgical pain control may lead to opioid use disorders problematic enough to persist in pregnancy and affect future offspring,” Auger and colleagues wrote. “Efforts to limit perioperative exposure to opioids and postoperative overprescribing in women should be further encouraged. Screening for opioid use disorders in pregnant women with a history of surgery may also help identify women who would benefit from opioid maintenance therapy earlier in pregnancy.” – by Erin Michael
Disclosures: Auger reported receiving grants from the Canadian Institutes of Health Research and the Fonds de recherche du Québec. Please see study for all other authors’ relevant financial disclosures.