Opioid Use Disorder in Pregnancy - Risks, Problems, and Treatment

Introduction:

Most women consider pregnancy as an emotional and trying time, mainly when associated with some addiction. In recent years, opioid usage during pregnancy has increased considerably. Opioids are a group of drugs that are used to reduce pain. Increased use of heroin and over-prescription of opioid pain medicines has resulted in opioid-related hospitalizations in young adults, including pregnant women. Usage of opioids during pregnancy can harm both the mother and the baby. When opioids are used during pregnancy, they pass through the mother’s system and reach the growing baby, causing the baby’s body to become dependent on the drug.

What Are Opioids?

Opioids are a group of drugs (natural or synthetic) that can potentially reduce pain by interacting with nerve cells. Generally, opioids, or narcotics, are prescribed by doctors to treat severe or persistent pain. When used according to the instructions given by the doctor, opioid medications are safe and effective in controlling acute pain, such as the pain experienced after surgery. However, opioid drugs may include both prescription pain medications and illegal drugs. Opioid drugs may include synthetic opioids like Fentanyl, illegal drug heroin, and pain relievers legally available by prescription, like Oxycodone, Codeine, morphine, and others.

How Do Opioids Work?

Opioid drugs travel through the blood and get attached to the opioid receptors present on the nerve cells in the brain, spinal cord, and other parts of the body. These nerve cells transmit signals that muffle the perception of pain and boost the feelings of pleasure. Opioids often create feelings of intense happiness as they make nerve cells produce dopamine, a neurotransmitter (chemical messenger of the body) that plays an important role in creating a feeling of pleasure.

What Is Opioid Use Disorder?

Opioid use disorder is a complex condition characterized by the compulsive use of opioid medicines even when a person wants to stop or when the opioid drugs negatively influence the physical and emotional well-being. In most cases, opioid use disorder involves the chronic usage of opioids which leads a person to significant impairment and distress. In addition, persons with opioid use disorder often have an overpowering desire to use opioids, a surge in opioid tolerance, and withdrawal syndrome when discontinued.

Is Opioid Use Safe During Pregnancy?

Opioid use during pregnancy has been associated with poor health for both the baby and the mother. Studies reveal that few pregnant women get prescription opioid pain relievers from sources other than a doctor, mostly used for reasons other than pain relief.

Maternal opioid overdose and the associated risk of aspiration, hypothermia, cardiovascular collapse, and coma can be life-threatening for the unborn baby. It is difficult to provide care for pregnant women with opioid use disorder during the peripartum period (shortly before and immediately after giving birth). In addition, prolonged use of opioids and the development of tolerance in pregnant women make them dependent on larger doses of pain medications than normal. This might lead to pregnant women being accused of “drug-seeking behavior” while the pain goes untreated.

What Are the Risks of Opioid Use Disorder in Pregnancy?

Fluctuating opioid levels in mothers may expose the unborn baby to repeated periods of withdrawal which in turn may harm placenta function. The risks associated with the fetus (unborn baby) can be divided into direct and indirect. They are as follows:

• Direct Risks

  • Neonatal abstinence syndrome.

  • Preterm labor.

  • Stunted growth.

  • Fetal convulsions.

  • Fetal death.

• Indirect Risks

  • Poor prenatal care and malnutrition.

  • High risk for maternal infections like HIV (human immunodeficiency virus), HCV (hepatitis C virus), or HBV (hepatitis B virus).

  • Dangers from drug seeking like violence and imprisonment.

What Are the Problems Caused by Opioids During Pregnancy and After Birth?

Using opioids during pregnancy has many harmful effects. Therefore, women who are using opioids and are not pregnant should use birth control measures until they are ready for pregnancy. This helps to reduce opioid-related complications once they get pregnant. The problems caused due to opioids during pregnancy and after birth are as follows:

• Birth Defects: Birth defects are health conditions present in a newborn baby during birth. It may alter the function or shape of one or more parts of the body and thereby cause problems in its overall health, development, or function. The commonly seen birth defects are as follows:

  • Gastroschisis: It is a birth defect in the baby’s belly, characterized by a hole beside the belly button. The intestines and other organs of the baby protrude outside the body through this hole.

  • Congenital Heart Defects: Congenital heart defects affect the shape and function of the baby’s heart.

  • Neural Tube Defects (NTDs): Neural tube defects are birth defects of the spinal cord, spine, or brain.

  • Glaucoma: Glaucoma is a group of eye conditions that may damage the optic nerve and cause blindness if left untreated.

• Miscarriage and Stillbirth: Miscarriage is the death of a baby inside the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby after 20 weeks of pregnancy.

• Neonatal Abstinence Syndrome (NAS): NAS is a group of complications experienced by a baby exposed to certain drugs in the womb before birth and undergoing withdrawal from the drug after birth. Usually, babies show signs of neonatal abstinence syndrome one to seven days after birth. Neonatal abstinence syndrome can be seen even in babies whose mothers have only taken opioids prescribed by the doctor. The symptoms seen in babies with neonatal abstinence syndrome are as follows:

  • Excessive crying and irritability.

  • Sleep problems.

  • Seizures.

  • Poor feeding and slow weight gain.

  • Vomiting, loose stools, and dehydration.

  • Stuffy nose or sneezing.

  • Excessive yawning.

  • Increased sweating.

  • Body shakes.

  • Fast breathing.

• Preeclampsia: Preeclampsia is a condition that occurs after 20 weeks of pregnancy or right after pregnancy in which the pregnant woman has high blood pressure and improper functioning of the organs like the liver and kidneys.

• Placental Abruption: It is a condition in which the placenta gets separated from the uterus wall before birth leading to deficient oxygen and nutrient supply to the baby in the womb, accompanied by severe bleeding.

• Preterm Labor and Preterm Birth: This includes labor and birth before 37 weeks of pregnancy. Opioids can cause premature rupture of membranes which causes the breaking of the sac around the baby before a woman goes into labor.

• Sudden Infant Death Syndrome (SIDS): SIDS is the unexplained death of a baby below one year. Babies born to opioid-using mothers are at high risk of sudden infant death syndrome.

How to Treat Opioid Use Disorder During Pregnancy?

The treatment methods for opioid use disorder during pregnancy are as follows:

• Behavioral Therapy: The doctor may advise the pregnant woman to undergo counseling, which can help to change her feelings about drugs and develop a healthy lifestyle. Counseling also helps prevent relapse, which is returning to using a drug after quitting.

• Opioid Replacement Therapy With Opioid-Assisted Therapy (OAT) Or Medication-Assisted Therapy (MAT): The doctor may prescribe long-acting opioids like Buprenorphine or Methadone to be taken during pregnancy and after the birth of the baby. Long-acting opioids stay in the body for a long period. Even though Buprenorphine and Methadone do not calm or make the pregnant woman feel happy like other opioids, these drugs reduce the need for opioids and are safe for both the baby and the mother. These drugs help to reduce the risks like growth problems in the baby and premature birth. In medication-assisted therapy, the doctor would prescribe a drug called Naloxone. Naloxone helps to reduce the harmful effects of opioids and also deals with opioid overdose. With a doctor’s prescription, Naloxone in small doses can be used by pregnant women.

• Close collaboration with a pediatrician would help in monitoring neonatal abstinence syndrome in infants who are born to women who use opioids during pregnancy.

• Screening for substance use during the first prenatal visit would help in identifying the opioid usage of the pregnant woman.

• Contraceptive counseling should be included as a part of the opioid use disorder treatment in women of reproductive age to avoid the risk of unplanned pregnancy.

• Postpartum psychosocial support services which include relapse prevention programs and opioid use disorder treatment should be made available for the mother.

Conclusion:

Opioid use disorder in pregnancy can have life-threatening effects on the unborn baby. Hence, it is important to identify and differentiate between opioid misuse, opioid use as medical care, and untreated opioid use disorder. Hence, early identification, brief intervention, and prompt treatment of pregnant women with opioid use disorder can improve maternal and infant outcomes.