Effects of Prenatal Opiate Exposure

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Background

The number of children with neonatal abstinence syndrome (NAS), who are born to women using opiates during pregnancy is steadily increasing to epidemic proportion. The use of opiates during pregnancy may result from substance abuse, treatment of chronic pain, or as a prescribes medication assisted treatment for opiate abuse or dependence. Even with the many experimental studies on the effects of prenatal opiate exposure on the developing brain, little is known as to the best treatment approach for NAS, the effects of treatment, and the long term outcomes of these children whether they were treated or not. The research topic entitled “Effects of Prenatal Opiate Exposure” will highlight what is currently known about NAS and the needed information that will further research in this area.

One manuscript will provide a historical perspective on NAS, addressing the changing prevalence of the disease over the years and the factors that may have contributed to its emergence as a public health problem. The overall significance of prenatal opiate exposure and neonatal abstinence syndrome will be demonstrated from research in experimental animals and evidence form clinical research. Readers and researchers will be interested in animal studies on effects of opiate on the developing brain at the different stages of development that may explain long-term behavioral effects, thus a basis for behavior teratology. Another component of the research topic will be directed specifically to the effects of prenatal opiate on the ontogeny of the stress axis especially when addiction researchers are familiar with the intersection of stress and drug use and the heritable aspect of drug addiction. Additionally, a component of this research topic will be directed to the effects of opiate, when used postnatally for the treatment of neonatal abstinence syndrome. Since experimental data strongly suggest detrimental effects from in-utero opiate exposure, it does not make sense why morphine is commonly used for treatment of NAS, when there is active brain growth in the first year few months of life.

From the clinical standpoint, one important aspect of prenatal opiate exposure will be the assessment and treatment of NAS to include current clinical experiences and controversies. Although there are specific signs and manifestations unique to neonatal opiate withdrawal, there is little information regarding the physiological changes associated with NAS, including but not limited to the functioning of the autonomic and central nervous system. Clinicians from different centers use different methods of assessment and there is also variation in the number of drugs used for pharmacologic treatment. Lastly, a pertinent area for discussion and research is the trajectory of outcomes of these affected children from various domains of neurobehavioral, motor, cognitive, and speech and language. A more important aspect is the mortality and morbidity in the newborn period through the first few months post discharge. Addressing outcomes should include the psychosocial and environmental issues that may mitigate or augment poor outcomes of babies with NAS. The detailed information resulting from the research topic will be able to address not only what is known about the condition but also any lack of evidence for current practices in assessment, treatment, and management of these children, promoting further and much needed research in the area.

Keywords: Prenatal opiate, neonatal abstinence, opiate withdrawal, developmental outcomes, pharmacological treatment

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