AAP calls for public health approach to opioid misuse by pregnant women

Opioid use in pregnancy has increased dramatically in the past decade, leading to increased rates of neonatal abstinence syndrome (NAS). The American Academy of Pediatrics (AAP) supports a public health-based approach to engage and protect these maternal-infant dyads.

Vanderbilt neonatologist Stephen Patrick, M.D., co-authored the AAP’s report, which states that, while some state governments have prosecuted and jailed mothers for substance use, these punitive measures provide no proven health benefits for mother or child and may lead to avoidance of prenatal care and substance use treatment.

“Over the last two decades, use of opioids surged throughout the U.S., and as they did, we have seen an increase in opioid-related complications in nearly every population, including pregnant women and their infants,” said Patrick, assistant professor of Pediatrics and Health Policy. “Our response should be grounded in public health. We should be bolstering efforts targeted at primary prevention, like prescription drug-monitoring programs, and expanding treatment tailored to the specific needs of pregnant women and their families.”

The policy statement, “A Public Health Response to Opioid Use in Pregnancy,” will be published in the March 2017 issue of Pediatrics and is available online.

The rate of infants born experiencing withdrawal symptoms, a condition known as neonatal abstinence syndrome, has grown nearly fivefold over the last decade, and by 2012, accounted for an estimated $1.5 billion in hospital charges, according to research. In 2012, one infant was born every 25 minutes with the condition nationwide – prompting attention from the public, providers and policymakers.

Besides improving access to contraceptives, prenatal care and treatment for substance use disorder, the AAP recommends:

• Universal routine screening for alcohol and other drug use in women of childbearing age
• Providing information and obtaining informed consent for maternal drug testing and reporting practices
• Improved access to comprehensive obstetric care, including opioid-replacement therapy
• Substance treatment programs specifically designed for pregnant women
• Improved funding for social services and child welfare systems

Access to comprehensive prenatal care and treatment for women with substance use disorders is associated with fewer preterm deliveries, small-for-gestational-age infants, and infants with low birth weight. Studies indicate that pregnancy can motivate women with substance use disorders to seek treatment; however, there remains a dearth of comprehensive treatment programs geared toward pregnant and parenting women.

Agencies/Canadajournal