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American Academy of Pediatrics
Article

Prescription Opioid Epidemic and Infant Outcomes

Stephen W. Patrick, Judith Dudley, Peter R. Martin, Frank E. Harrell, Michael D. Warren, Katherine E. Hartmann, E. Wesley Ely, Carlos G. Grijalva and William O. Cooper
Pediatrics April 2015, peds.2014-3299; DOI: https://doi.org/10.1542/peds.2014-3299
Stephen W. Patrick
Departments of aPediatrics,
bMildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee;
cVanderbilt Center for Health Services Research, Nashville, Tennessee;
dHealth Policy,
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Judith Dudley
dHealth Policy,
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Peter R. Martin
ePsychiatry,
fPharmacology,
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Frank E. Harrell
gBiostatistics,
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Michael D. Warren
hTennessee Department of Health, Nashville, Tennessee; and
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Katherine E. Hartmann
cVanderbilt Center for Health Services Research, Nashville, Tennessee;
iObstetrics and Gynecology, and
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E. Wesley Ely
cVanderbilt Center for Health Services Research, Nashville, Tennessee;
jMedicine, Vanderbilt University, Nashville, Tennessee;
kVeteran’s Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
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Carlos G. Grijalva
cVanderbilt Center for Health Services Research, Nashville, Tennessee;
dHealth Policy,
kVeteran’s Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
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William O. Cooper
Departments of aPediatrics,
cVanderbilt Center for Health Services Research, Nashville, Tennessee;
dHealth Policy,
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Abstract

BACKGROUND AND OBJECTIVES: Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS).

METHODS: We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.

RESULTS: Of 112 029 pregnant women, 31 354 (28%) filled ≥1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67–2.60]) were associated with greater risk of developing NAS.

CONCLUSIONS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.

  • neonatal abstinence syndrome
  • neonatal drug withdrawal syndrome
  • neonatal opioid withdrawal syndrome
  • opioid pain reliever
  • Accepted February 10, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 4
1 Apr 2021
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Prescription Opioid Epidemic and Infant Outcomes
Stephen W. Patrick, Judith Dudley, Peter R. Martin, Frank E. Harrell, Michael D. Warren, Katherine E. Hartmann, E. Wesley Ely, Carlos G. Grijalva, William O. Cooper
Pediatrics Apr 2015, peds.2014-3299; DOI: 10.1542/peds.2014-3299

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Prescription Opioid Epidemic and Infant Outcomes
Stephen W. Patrick, Judith Dudley, Peter R. Martin, Frank E. Harrell, Michael D. Warren, Katherine E. Hartmann, E. Wesley Ely, Carlos G. Grijalva, William O. Cooper
Pediatrics Apr 2015, peds.2014-3299; DOI: 10.1542/peds.2014-3299
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Subjects

  • Public Health
    • Public Health
  • Fetus/Newborn Infant
    • Fetus/Newborn Infant
    • Neonatology

Keywords

  • neonatal abstinence syndrome
  • neonatal drug withdrawal syndrome
  • neonatal opioid withdrawal syndrome
  • opioid pain reliever
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