The study’s findings might cause medical providers to reconsider what is the best standard of care for pregnant women with opioid addiction, according to the lead study author.
A study released this week found that infants who are exposed to opioids in the womb have significantly smaller head sizes at birth than babies who were not exposed to opioids, suggesting that they are at increased risk of mental health and developmental problems and potentially calling into question the standard treatment for women with opioid use disorder who discover they are pregnant.
The study, published in the journal Pediatrics, found that infants who were exposed to opioids were three times more likely to have a head circumference that measured in the bottom 10%. A small head circumference has previously been linked to mental health problems and developmental delays.
“Babies chronically exposed to opiates [during pregnancy] had a head size about a centimeter smaller’ than babies born to moms not using drugs,” said Dr. Craig Towers, lead study author and professor of obstetrics and gynecology with the University of Tennessee Medical Center in Knoxville. This included babies whose mothers were on medication-assisted treatment with methadone or buprenorphine, the current standard of care for women who discover they’re pregnant while abusing opioids.
Towers said that the findings might cause medical providers to reconsider what is the best standard of care for pregnant women who are addicted to opioids.
“What we’re recommending these moms do, which is get on methadone and buprenorphine, may result in a smaller head size of the baby,” Towers said. “This is going to have to make us re-look at what we’re doing.”
During the study, mothers were routinely screened for drugs so that researchers could control for the influence of alcohol or illicit drugs other than opioids. With this information, they were able to definitively link opioid exposure and lower head circumference.
Although the results may call into question the use of prescribed opioids during pregnancy, Towers said that putting women on maintenance therapy remains the best option for now. Women who are abusing opioids and stop suddenly can experience withdrawal that may cause them to miscarry or can increase their risk of relapse, which can have fatal results for both mom and baby.
“I don’t want anyone to think putting them on methadone or buprenorphine is not the way to go. If they continue to use street drugs, that’s exponentially worse,” Towers said. With prescribed drugs, a woman and her doctor at least know exactly what she is taking, he said.
He said the study could encourage more conversations between women and their care providers.
“There are risks to the mom if she tapers and detoxes, but there are risks to the baby if she stays on maintenance therapy,” Towers said. “There needs to be informed consent so the mother can choose how she wants to go.”
Dr. Mark Hudak, a professor of pediatrics at the University of Florida College of Medicine who wrote an editorial accompanying the study, said that the research is likely to be “very controversially received.”
“I think there’s going to be pushback on it, but one has to follow the evidence,” he said. ”The whole pillar of opioid maintenance therapy is based upon the fact this is better for the mother and the baby in the sense that the mother is in therapy, she is more closely monitored, she’s more likely to access good prenatal care, she’s less likely to engage in behaviors that would be harmful to her or the fetus… You now have to ask, is that the only or the best way for all women.”
