Opioid Use In Pregnant Women and its Effect on the Development of Neonatal Abstinence Syndrome in Newborns

Abstract

The current guidelines for chronic noncancer pain management by the American Pain Society rec- ommends opioids as the therapeutic choice to lessen pain and/or recover physical and psychological functioning. However, misuse of opioids during pregnancy has become an alarming concern across the United States impacting the health of both the mother and newborn. Infants experiencing opioid with- drawal symptoms, also known as neonatal abstinence syndrome (NAS), are at higher morbidity risk and other long-term developmental risks that are yet to be understood. In this review, five quality studies were assessed and analyzed to make recommendations on methadone and morphine-derivative opioid use for chronic pain management in pregnant women. Methadone has proven to be an effective option for moderate to severe pain and relatively safer than other opioid choices if prescribed at a reduced dose of 30 mg daily for 7 weeks. Codeine can be selected for mild to moderate chronic pain management and should not exceed 60 mg every 4 hours for patients in the third trimester. However, it is inferior for pain relief compared to morphine, whereas methadone is comparable. Both dosing recommendations are expected to have decreased risk of NAS development compared to dosing used in literature.