title: Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant.
abstract: Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for "personalized genomic medicine" and novel, individualized therapeutic interventions.
authors.affiliation: Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kraft
authors.affiliation: Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA.
authors.forename: Megan W
authors.initials: MW
authors.lastname: Stover
authors.affiliation: Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, TMC 44, 800 Washington St, Boston, MA 02111; Tufts Clinical and Translational Science Institute, Tufts, Boston, MA. Electronic address: jdavis@tuftsmedicalcenter.org.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Davis
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001463:Barbiturates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D054539:Medication Therapy Management; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000209:etiology / Q000235:genetics / Q000628:therapy; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000628:therapy*; D000071184:Pharmacogenomic Variants; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011297:Prenatal Exposure Delayed Effects / Q000517:prevention & control
chemical_list: D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D001463:Barbiturates
keywords: Neonatal abstinence syndrome; Newborn; Opioids; Pregnancy