Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Discuss the findings of a study that sought to identify neonatal complications associated with antenatal opioid exposure and examined predictors of neonatal abstinence syndrome.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at http://akhcme.com/akhcme/lessons/35. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Take CME(click to view)
Recent data show that that the number of prescriptions being written for opioids to manage pain has quadrupled over the past decade in the United States. In 2012, it was estimated that 259 million prescriptions were written for opioids, a figure that amounts to one prescription for every American adult currently living in the U.S. Research suggests that opioids are commonly prescribed in pregnancy, however studies evaluating their association with neonatal outcomes are limited.
In the past, studies have described the effect of drug withdrawal on infants born to mothers who used drugs illicitly, such as heroin or among women receiving medication-assisted treatment. Few studies, however, have examined the dispensing of legal opioid prescriptions for pregnant women. “In light of the nation’s current prescription opioid epidemic, it’s important to look at how these drugs are used by pregnant women and its impact on outcomes for mothers and infants,” says Stephen W. Patrick, MD, MPH, MS.
Exploring the Issue
In a study published in Pediatrics, Dr. Patrick and colleagues sought to identify neonatal complications that were associated with antenatal opioid exposure. The authors also examined predictors of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants following birth that—according to previous research—has been linked to about $720 million per year in national healthcare expenditures for treatment. Previously, studies have suggested that opioid use during pregnancy increases risks for NAS.
The study group used prescription and administrative data that was linked to vital statistics for mothers and infants who were enrolled in the Tennessee Medicaid program between 2009 and 2011. The authors then looked at a random sample of NAS cases that were validated by a medical record review. They assessed the association of antenatal exposures with NAS using multivariable logistic regression and controlled for maternal and infant characteristics.
A Common Occurrence
Of the more than 112,000 pregnant women who were analyzed in the study, over 31,000—or 28%—filled one or more prescriptions for opioids. “This illustrates the fact that pregnant women are commonly being prescribed opioids,” says Dr. Patrick. Babies who were exposed to opioids were more likely to be born preterm, have low birth weights, and develop complications like NAS, meconium aspiration syndrome, and respiratory distress. “In addition,” Dr. Patrick says, “about two-thirds of babies who had NAS were born to mothers that legally filled prescriptions for opioids.”
Other Key Findings
The study also found that women who were prescribed opioids were more likely than those who were not to have depression or an anxiety disorder and to smoke tobacco. About 21% of infants with NAS were born at a low birth weight, compared with rates of about 12% for infants exposed to opioids and 10% for infants not exposed to opioids.
Several factors were shown to increase risks for NAS by two-fold, according to the data (Table). These include opioid type and duration of exposure as well as daily tobacco use and selective serotonin reuptake inhibitor use. Not all babies exposed to opioids had drug withdrawal after birth, a finding that Dr. Patrick says warrants more research. Studies are needed to determine the reasons and risk factors for withdrawal symptoms among neonates from opioid use during pregnancy.
When compared with women who had no opioid exposure, pregnant women who used opioids were more likely to be Caucasian, have anxiety or depression, suffer from headaches or migraines, and have musculoskeletal diseases. The majority of women who were prescribed opioids during the study were given short-acting medications. However, 2% received maintenance doses of opioids while less than 1% received long-acting opioids.
Assessing the Implications
“Much of the focus regarding the opioid epidemic has been directed toward adults, but our research shows that more attention should be paid to pregnant women who use these powerful drugs as well as infant outcomes,” says Dr. Patrick. The study notes that the financial impact of outcomes associated with opioid use during pregnancy is also substantial. The study notes that every $1 spent on short-acting opioids in pregnancy was associated with $52 in hospital charges for NAS.
Many states throughout the U.S. have initiated programs like prescription drug monitoring databases to combat overprescribing and “doctor shopping” for opioids. Many healthcare providers and pharmacists across the country are now required by law to use these systems. Including more data on opioid use among pregnant mothers in these monitoring systems may improve neonatal outcomes. “We hope our study gains the attention of state and federal policy makers,” Dr. Patrick says. “Our findings highlight the fact that the prescription opioid epidemic is having a tangible impact on mothers and infants.”
Readings & Resources (click to view)
Patrick SW, Dudley J, Martin PR, et al. Prescription opioid epidemic and infant outcomes. Pediatrics. 2015 Apr 13 [Epub ahead of print]. Available at: http://pediatrics.aappublications.org/content/early/2015/04/08/peds.2014-3299.abstract.
Kaltenbach K, Holbrook AM, Coyle MG, et al. Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction. 2012;107(Suppl):45-52.
Creanga AA, Sabel JC, Ko JY, et al. Maternal drug use and its effect on neonates: a population-based study in Washington State. Obstet Gynecol. 2012;119:924-933.
McLemore GL, Lewis T, Jones CH, Gauda EB. Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome. Semin Fetal Neonatal Med. 2013;18:35-41.