Summary: Opioids are not prescribed in pregnancy. However, so many people are living with opioid use disorder (OUD). Thus, it is no surprise that many pregnant women are exposed to opioids. Opioid Use Disorder (OUD) causes many pregnancy related complications like increased risk of preterm birth. However, now a study shows that opioid exposure during pregnancy also results in a smaller fetal brain. Thus, OUD may have long-term implications for children born to women living with OUD.
Doctors are unlikely to recommend opioids in pregnancy. However, about 2.7 million people are living with opioid use disorder symptoms (OUD) in the US alone. The vast majority of them are addicted to prescription opioids and some to street drugs. Hence, many fetuses are exposed to opioids in their early life. Fetuses, that is, unborn offspring, differ from adults. It is a stage when an organism is growing fast, and body structures are still forming. Thus, a kind of side effects would also differ in pregnancy. Opioid exposure not only harms women’s health but may also cause significant harm to fetal development.
There are many studies focused on the harm of OUD during pregnancy. Studies show that it results in preterm birth, stillbirths, higher maternal mortality, and more2. However, there are still very few studies regarding the impact of opioid exposure during pregnancy and fetal brain development.
The new study published in the American Journal of Roentgenology found that opioid exposure leads to poor fetal brain development. Thus, women exposed to opioids during pregnancy have fetuses with smaller brains compared to those not exposed to opioids3. The study was done at multiple centers in the US. Doctors included those women in the study who had to undergo MRI in their third trimester. During the investigation, they marked the women as either opioid exposed or not exposed to opioids.
A total of 28 fetal scans were of opioid-exposed women, and 37 fetal scans were of unexposed. When they corrected for fetal age and other confounding factors, they found that fetuses exposed to opioids had significantly smaller brain sizes than those unexposed. They also found increased amniotic fluid volume (29% vs. 8%) and a considerably higher risk of breech position. This study shows the magnitude of the problem of health threats posed by OUD. However, it should not be viewed merely as a condition causing overdose deaths or few pregnancy complications. Its harms may be even graver, and many harms are challenging to measure.
Smaller brain size is just one thing. However, it is quite challenging to measure how due to OUD, each year, hundreds of children are being born that may experience various disabilities later in their life. It shows how OUD may influence generations to come. Children born to parents living with OUD may have numerous mental health issues, neurodevelopmental issues, a higher risk of physical ailments, and more. This study has just explored the tip of the iceberg. Nonetheless, it is a study in the right direction. It shows that statistics regarding drug addiction, related disabilities, and mortality do not show a complete picture. It also shows the vitality of treating OUD symptoms in young adults. By treating these disorders, we are helping young adults and doing a great service to the coming generation.
Additionally, it also shows that clinicians should be careful prescribing opioids to young adults, especially women of childbearing age. There is also a need to increase awareness regarding health threats posed by opioid abuse in young adults, especially those planning to have a child. Additionally, this study should form the basis for further studies into the topic. There is also a need to explore health issues in children born to parents living with OUD. This will help provide timely help to these children.
By Gurpreet Singh Padda, MD, MBA, MHP