Infants whose mothers underwent surgery during pregnancy may be at increased risk of opioid withdrawal symptoms at birth.
Addiction to opioids, these powerful drugs derived from morphine, does not only wreak havoc on adults. This addiction can also affect very young children and newborns. This is highlighted by a new study from the University of Montreal Hospital Research Center (CRCHUM) published in the Canadian Medical Association Journal.
According to its main author, Dr. Nathalie Auger, these painkillers available on prescription and regularly prescribed after surgery increase the risk of dependence, not only in the mother, but also in her child if she becomes pregnant after the operation. “The use of opioids to control pain after surgery may increase the risk of opioid addiction in women and withdrawal in newborns,” explains the researcher.
A health risk for infants
“We found that mothers who had surgery before pregnancy had a 1.6 times higher risk of neonatal abstinence syndrome (NAS) – that is, opioid withdrawal symptoms in their future newborns – possibly because opioid use continues after surgery.”
According to the Canadian Pediatric Society, neonatal abstinence syndrome is a very disturbing phenomenon for the health and early development of the brain. It can cause disruption of the mother-infant relationship, sleep/wakefulness abnormalities, feeding difficulties, weight loss, and seizures.
To measure the risk of opioid dependence of infants whose mothers had undergone surgery before pregnancy, the researchers analyzed data from nearly 2.2 million pregnancies that took place in Quebec between 1989 and 2016. Among the babies of the sample, 2,346 suffered from neonatal abstinence syndrome, including 1,052 whose mothers had undergone surgery before pregnancy (14.9 per 10,000 babies) compared to 1,294 babies (8.8 per 10,000 ) born to non-operated mothers.
Greater vigilance of doctors
By analyzing the results, the researchers found that certain factors favored the neonatal abstinence syndrome. This is particularly the case for multiple surgeries, a young age at the time of surgery, a longer time between surgery and pregnancy. Cardiovascular, thoracic, urological or neurosurgical interventions are also associated with a greater risk of newborn dependence on opioids.
They also noticed that there was a strong association with general anesthesia. According to them, this is probably because this type of anesthesia is used in more complex surgeries, which may require longer use and a higher dosage of painkillers.
“Physicians have the potential to prevent neonatal abstinence syndrome through careful postoperative pain management in young women,” says Dr. Auger. “Opioids continue to be overprescribed, despite calls to optimize postoperative pain control through improved surgical guidelines and the use of multipronged approaches with nonopioid analgesics or local anesthetics.”
To limit the risk of dependence in newborns and therefore reduce the risk of neonatal abstinence syndrome, it thus recommends “limiting postoperative exposure to opioids, reducing over-prescription and screening for opioid use in pregnant women. who have already had surgery.
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