Use of opiates in pregnancy

 

The use of opioids during pregnancy can negatively affect neonates, with an 85% likelihood of neonatal abstinence syndrome (NAS) if the mother has used any type of opioid during pregnancy (including substitutes).

 

The syndrome describes the series of symptoms that are seen due to withdrawal from the drug after the cessation of gestational exposure. A study carried out in America between 2000- 2009 found that NAS occurred in 5.63 births out of every 1000.

 

Neonatal opioid withdrawal symptoms

The withdrawal symptoms initially worsen as the drug level lowers after birth as the drug is no longer being passed to the neonate via the placenta. If the mother was using heroin or other opioids, then the onset is within 24 hours of birth, whereas if a substitute (methadone or buprenorphine) has been used, this can take longer to manifest, usually between 48-72 hours but has been seen up to 7 days after birth.

 

The side effects are neurological, gastrointestinal and autonomic in origination, including:-

• increased muscle tone

• tremor

• a high pitched cry

• poor feeding

• irritability

• poor weight gain

• diarrhoea

• temperature instability

• nasal congestions

• occasionally seizures.

 

Treatment

Usually first line treatment is with opiates, with oral morphine solution being preferred (due to not containing alcohol or other additives), but opium tincture, methadone and buprenorphine can also be given. Phenobarbital or clonidine can be used concurrently in order to decrease the duration of symptoms and the length of the hospital stay.

 

Non pharmacological methods include:-

 

• Breastfeeding- this helps to decrease NAS symptoms, potentially due to a small, safe amount of buprenorphine or methadone being transferred from the mother to the child. It can also be protective against Sudden Infant Death Syndrome (SIDS) which is more prevalent if the mother was using methadone throughout the pregnancy

• Rooming in- the baby remains in the same room as the mother, which may reduce anxiety of both mother and child and build a bond between them

• Skin to skin contact- increases the maternal bond with the baby which has been shown to reduce crying

• Swaddling (where the baby is tightly wrapped in blankets)- increases the amount of sleep and reduces crying, but care needs to be taken to ensure hyperthermia does not occur due to the child’s lack of temperature control