Opioid Crisis in Pregnant Women

Drug overdoses remain the leading cause of injury-related death in the U.S. according to the U.S. Department of Health and Human Services, and the growing opioid epidemic across the country is a huge driver for this phenomenon. A recent New York Times article cited that overdoses are the leading cause of death for Americans under 50 years of age, but one subpopulation affected by this crisis tends to get lost behind the headlines—pregnant women.

Historically, women have experienced a higher rate of being prescribed and, thus, using opioids than men. This trend potentially puts women at a higher risk of becoming dependent on or addicted to opioids than men. On the flip side, a phenomenon known as the “telescoping effect” involves a shorter duration of time between when women begin using opioids and when they begin seeking treatment for misuse compared to men. Some scholars attribute this phenomenon to the greater difficulty women may have in hiding their substance use disorder than men because of gendered social responsibilities.

Gender disparities have even been observed in how healthcare providers have been trained to respond to opioid misuse. For instance, until very recently, many first responders looking to administer naloxone for overdoses were only trained to look for “men surrounded by needles” before the realization that many women were taking opioids orally rather than intravenously. Major risk factors for opioid use disorder include misuse of other substances and major depression, which also tends to affect women more than men.

As one might imagine, opioid use is less prevalent among pregnant women than among non-pregnant women. Furthermore, opioids remain a small fraction of the overall substances used by both groups of women, which is why healthcare providers should not ignore other forms of substance use when screening in patients.

The consequences of opioid misuse cannot be understated, especially in women who are pregnant. Prenatal exposure to opioids can result in a condition called Neonatal Abstinence Syndrome (NAS). While most people have heard of Fetal Alcohol Syndrome, this condition presents differently, as it is more transient and can potentially be reversed with appropriate treatment, namely early administration of morphine. The natural history of NAS is also dependent on the child’s interaction with his/her environment and caregiver(s).

It should be noted that prenatal exposure to opioids is not the only cause of NAS, as it can also result from prenatal exposure to SSRIs and tobacco. The child’s risk of developing NAS does not have a dose-dependent relationship with prenatal exposure to opioids; rather, other factors, including genetics and prenatal exposure to SSRIs and tobacco have a much bigger impact than the actual dose of opioids.

Current research has proven that medication-assisted treatment is more effective than detoxification in the rehabilitation of opioid addicts. Methadone and buprenorphine are the mainstays of treatment. Methadone has more potent effects than buprenorphine; however, methadone carries the risk of causing respiratory and cardiac depression, while buprenorphine carries a lower risk for overdose.

Studies measuring the safety of administering methadone and buprenorphine to addicted pregnant women show that there is significantly less need for morphine in the treatment of NAS in newborns if buprenorphine is administered to mothers during pregnancy rather than methadone.

Many professionals in the field of studying and treating substance misuse attest that the single most important target of intervention for any substance use disorder is patient education. Programs across the country follow this model. One such program is the University of North Carolina-Chapel Hill Horizons program, which has been doing groundbreaking multimodal and interdisciplinary work with pregnant women and their families struggling with addiction for over 25 years. Recently, it has reported a 100% improvement in Child Protective Services cases. Much of the information cited in this very post is from a recent talk given by Dr. Hendrée Jones, a lead researcher at the Horizons program at Northwestern Memorial Hospital.

Public health efforts continue to focus on education not only of patients but also on health professionals, law enforcement and other people who can intervene in the fight toward reducing the devastating effects of this opioid crisis.

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