MedicalResearch.com Interview with:
Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood.
In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: The increased risks of neonatal drug withdrawal in women concomitantly using opioids and antidepressants, benzodiazepines, or gabapentin suggest that clinicians should be cautious in prescribing these medications together in late pregnancy and in prescribing psychotropic medications to women with known or suspected illicit opioid use.
Because pain and mental health conditions often co-occur, co-exposure will be unavoidable in many instances. In those cases, our findings may be helpful in risk stratification for exposed infants.
Our findings also imply that it will be important for neonatologists and pediatricians to rethink treatment protocols for infants born to women who were prescribed multiple drugs during their pregnancy.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: As a next step, it would be helpful to quantify the risk of neonatal drug withdrawal in infants born to women with exposure to illicit opioids combined with psychotropic medications in pregnancy. The absolute risks are likely to be higher in this group.
MedicalResearch.com: Is there anything else you would like to add?
Response: As always, treatment decisions in pregnancy involve weighing the risks and benefits of treatment for both the mother and the newborn. The risk of neonatal drug withdrawal is only one of the risks that should factor in this decision.
The authors have no specific disclosures related to this manuscript.
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Krista F Huybrechts, Brian T Bateman, Rishi J Desai, Sonia Hernandez-Diaz, Kathryn Rough, Helen Mogun, Leslie S Kerzner, Jonathan M Davis, Megan Stover, Devan Bartels, Jennifer Cottral, Elisabetta Patorno. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ, 2017; j3326 DOI: 10.1136/bmj.j3326
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