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Sad statistics regarding fetal harm from maternal drug use

Robin Wulffson MD's picture
pregnancy, drug use, illegal drugs, prescription drugs, fetal harm

Despite the fact that fetal damage may occur, many women take prescription and illegal drugs during their pregnancy. To evaluate fetal impact from maternal drug use, a large population-based study was conducted. The findings were presented in the May 2012 edition of the journal Obstetrics & Gynecology.

The investigators reviewed state-linked birth certificate and hospital discharge (mother and newborn) data from 2000 through 2008 in Washington State. Their focus was to estimate the effect of maternal illegal and prescription drug use on their offspring. The data was used to calculate prenatal drug exposure and neonatal abstinence syndrome rates (neonatal abstinence refers to the newborn’s withdrawal from the drugs). The researchers compared state neonatal abstinence syndrome rates with national-level data from the Nationwide Inpatient Sample. They identified the drugs of exposure, examined predictors of drug exposure and neonatal abstinence syndrome, and assessed perinatal (time of birth) outcomes among drug-exposed and neonatal abstinence syndrome-diagnosed neonates compared with unexposed neonates.

The researchers found that drug exposure and neonatal abstinence syndrome rates increased significantly between 2000 and 2008; furthermore, the neonatal abstinence syndrome rates in Washington State were consistently higher than national figures (3.3 per 1,000 births vs. 2.8 per 1,000 births in 2008). The percentage of neonatal abstinence syndrome-diagnosed neonates exposed prenatally to opioids (i.e., heroin or codeine) increased from 26.4% in 2000 to 41.7% in 2008. Compared with unexposed newborns, drug-exposed and neonatal abstinence syndrome-diagnosed neonates had a lower average birth weight, longer birth hospitalization, were more likely to be born preterm, experience feeding problems, and have respiratory conditions.

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The authors concluded that, in recent years, maternal use of illicit and prescription drugs was associated with considerable neonatal morbidity and significantly higher rates of drug exposure and neonatal abstinence syndrome. Their data suggested that opioid analgesics (pain killers) contributed to the increase in prenatal drug exposure and neonatal abstinence syndrome in Washington State. They stressed that, in accordance with current guidelines, their findings indicated the need for healthcare providers to screen pregnant women for illegal and prescription drug use and minimize use of opioid analgesics during pregnancy.

The authors noted that in utero exposure to illegal drugs, including street and prescription drugs used non-medically, as well as methadone prescribed as treatment for opiate addiction can have negative effects on fetal development and potentially on subsequent infant, child, and adult health. Prematurity, fetal growth restriction, and neonatal abstinence syndrome are well-established immediate effects of prenatal exposure to certain drugs. Neonatal abstinence syndrome represents a spectrum of behavioral and physiological signs and symptoms that occur in a newborn exposed to addictive illegal or prescription drugs while in the uterus, and, depending on exposure patterns, may require significant intervention with drug therapy.

Reference: Obstetrics & Gynecology

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