A public health official advises against the use of opioids during pregnancy, unless absolutely necessary, in an editorial published in BMJ. Dr. Nora D. Volkow , director of the National Institutes of Health’s National Institute on Drug Abuse, cites both the known risks to fetuses associated with opioid use by mothers to be and the paucity of research on the full effects of opioid use by pregnant women on their babies as reasons for her campaign.

“The lack of scientific information on the effects of opioids on fetal brain development, combined with their known association with NAS [neonatal abstinence syndrome] indicates that opioids should be reserved for pregnant women with severe pain that cannot be controlled through more benign means, and ideally limited to short-term use,” she says.

In fact, a rise in the incidence of NAS from 1.20 to 3.39 per 100 live births that occurred between 2000 and 2009 was a “likely consequence” of an increase in opioid prescriptions to pregnant women, she adds.

Furthering her argument against opioid use by pregnant women, Dr. Volkow points out an increased risk of additional abnormalities occurring in infants that have been associated with opioid use during pregnancy in human epidemiological studies. Such abnormalities include neural tube defects and other birth defects. She adds that cognitive impairments have been reported in the offspring of women who misused opioids during pregnancy.

While Dr. Volkow acknowledges that the “risk of NAS is greater if opioids are taken closer to the delivery day or for longer periods and if the drugs have short breakdown times,” she said any pregnant woman who must use opioids should be carefully monitored and assessed “to minimize the risk of overdoses, NAS, and misuse.”

Read the editorial in BMJ ( doi: 10.1136/bmj.i19 ).


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