Chronic Opiate Use in Pregnancy and Newborn Head Circumference

Abstract

Objective The aim of the study is to evaluate whether chronic opiate use in pregnancy affects newborn head circumference (HC).

Study Design All newborns from January 1, 2010, to June 30, 2012, admitted to the neonatal intensive care unit for treatment of neonatal abstinence syndrome were prospectively collected. The demographic, obstetrical, neonatal, and perinatal ultrasound data were retrospectively obtained. A gestational age-matched control was used for comparison purposes.

Results Of 332 neonates admitted for the treatment of neonatal abstinence syndrome, 98 (29.5%) had a HC ≤ 10th percentile for gestational age that was significantly increased when compared with controls (p < 0.001). Of these 98, 25 had a HC ≤ 3rd percentile. Of the case population, 141 had an ultrasound in the perinatal unit within 10 days of birth. A HC < 5th percentile was found in 38.3% of cases of which 74% were ≤ 10th percentile postdelivery. The ultrasound femur and humerus length measurements were also < 5th percentile in 36.2 and 28.9%, respectively.

Conclusion Chronic opiate use in pregnancy appears to increase the risk for a HC ≤ 10th percentile and ≤ 3rd percentile when compared with controls. From ultrasound findings, femur and humerus lengths also appear to be shortened suggesting a possible effect on bone growth.

Keywords

opiates - neonatal abstinence syndrome - newborn head circumference - prenatal substance abuse

• References

• 1 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
• 2 Joint Commission on Accreditation of Healthcare Organizations Pain Assessment and Management: An Organizational Approach; 2000. Available at http://www.jointcommission.org/assets/1/18/pain_management.pdf
• 3 Public Law 106–386-Oct. 28, Victims of Trafficking and Violence Protection Act of 2000. Title VI, Section 1603, “Decade of pain control and research.” 2000
• 4 National Institute on Drug Abuse. Commonly Abused Prescription Drugs. Bethesda, MD: NIDA; 2011. . Available at: https://www.drugabuse.gov/sites/default/files/rx_drugs_placemat_508c_10052011.pdf
• 5 Delsing C, Van Den Wittenboer E, Liu AJW , et al. The relationship between maternal opiate use, amphetamine use and smoking on fetal growth. Aust N Z J Obstet Gynaecol 2011; 51 (5) 446-451
• 6 Arlettaz R, Kashiwagi M, Das-Kundu S, Fauchère J-C, Lang A, Bucher H-U. Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources. Acta Obstet Gynecol Scand 2005; 84 (2) 145-150
• 7 Hagopian GS, Wolfe HM, Sokol RJ, Ager JW, Wardell JN, Cepeda EE. Neonatal outcome following methadone exposure in utero. J Matern Fetal Med 1996; 5 (6) 348-354
• 8 Lam SK, To WK, Duthie SJ, Ma HK. Narcotic addiction in pregnancy with adverse maternal and perinatal outcome. Aust N Z J Obstet Gynaecol 1992; 32 (3) 216-221
• 9 Little BB, Snell LM, Klein VR, Gilstrap III LC, Knoll KA, Breckenridge JD. Maternal and fetal effects of heroin addiction during pregnancy. J Reprod Med 1990; 35 (2) 159-162
• 10 Das A, Poole WK, Bada HS. A repeated measures approach for simultaneous modeling of multiple neurobehavioral outcomes in newborns exposed to cocaine in utero. Am J Epidemiol 2004; 159 (9) 891-899
• 11 Bada HS, Bauer CR, Shankaran S , et al. Central and autonomic system signs with in utero drug exposure. Arch Dis Child Fetal Neonatal Ed 2002; 87 (2) F106-F112
• 12 Tennessee Department of Health. Maternal and Child Health/Neonatal Abstinence Syndrome. Available at: http://health.tn.gov/MCH/NAS ; Accessed March 2013
• 13 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (2) e214-e224
• 14 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol 1985; 151 (3) 333-337
• 15 Nardozza LM, Araujo Júnior E, Barbosa MM, Caetano AC, Lee DJ, Moron AF. Fetal growth restriction: current knowledge to the general Obs/Gyn. Arch Gynecol Obstet 2012; 286 (1) 1-13
• 16 Restriction FG ; American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (5) 1122-1133
• 17 Jones KL. The effects of alcohol on fetal development. Birth Defects Res C Embryo Today 2011; 93 (1) 3-11
• 18 Rementeriá JL, Nunag NN. Narcotic withdrawal in pregnancy: stillbirth incidence with a case report. Am J Obstet Gynecol 1973; 116 (8) 1152-1156
• 19 Zuspan FP, Gumpel JA, Mejia-Zelaya A, Madden J, Davis R.. Fetal stress from methadone withdrawal. Am J Obstet Gynecol 1975; 122 (1) 43-46
• 20 Dashe JS, Jackson GL, Olscher DA, Zane EH, Wendel Jr GD. Opioid detoxification in pregnancy. Obstet Gynecol 1998; 92 (5) 854-858
• 21 Luty J, Nikolaou V, Bearn J. Is opiate detoxification unsafe in pregnancy?. J Subst Abuse Treat 2003; 24 (4) 363-367
• 22 Stewart RD, Nelson DB, Adhikari EH , et al. The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy. Am J Obstet Gynecol 2013; 209 (3) e1-e5
• 23 Minnes S, Lang A, Singer L. Prenatal tobacco, marijuana, stimulant, and opiate exposure: outcomes and practice implications. Addict Sci Clin Pract 2011; 6 (1) 57-70