title: Prescription opioid epidemic and infant outcomes.
abstract: OBJECTIVE
  Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS).
  
  
  METHODS
  We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.
  
  
  RESULTS
  Of 112,029 pregnant women, 31,354 (28%) filled ≥ 1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.
  
  
  CONCLUSIONS
  Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.
authors: Departments of Pediatrics, Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy, stephen.patrick@vanderbilt.edu.
authors: Stephen W
authors: SW
authors: Patrick
authors: Health Policy.
authors: Judith
authors: J
authors: Dudley
authors: Psychiatry, Pharmacology.
authors: Peter R
authors: PR
authors: Martin
authors: Biostatistics.
authors: Frank E
authors: FE
authors: Harrell
authors: Tennessee Department of Health, Nashville, Tennessee; and.
authors: Michael D
authors: MD
authors: Warren
authors: Vanderbilt Center for Health Services Research, Nashville, Tennessee; Obstetrics and Gynecology, and.
authors: Katherine E
authors: KE
authors: Hartmann
authors: Vanderbilt Center for Health Services Research, Nashville, Tennessee; Medicine, Vanderbilt University, Nashville, Tennessee; Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee.
authors: E Wesley
authors: EW
authors: Ely
authors: Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy, Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee.
authors: Carlos G
authors: CG
authors: Grijalva
authors: Departments of Pediatrics, Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy.
authors: William O
authors: WO
authors: Cooper
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D055553:Prescription Drugs; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: neonatal abstinence syndrome; neonatal drug withdrawal syndrome; neonatal opioid withdrawal syndrome; opioid pain reliever