Science On Tap

We are all familiar with Fetal Alcohol Syndrome (FAS). When alcohol from the mother’s blood passes to a fetus through the umbilical cord, it reaches the fetus’s brain, inhibiting development. FAS impacts from 0.2 to 1.2 infants in every 1,000 births, causing learning disabilities, kidney and liver problems, and abnormal facial features. FAS is life changing and is a major diagnosis for a newborn; however, it is tricky from the public health side of things. Because many women do not know that they are pregnant until 4 to 6 months later, it is difficult to ensure that fetuses are not exposed to a single drop of alcohol. It seems unfair to place the blame on the mother, especially since she didn’t know she was pregnant.

Now, we have parallel public health concerns when it comes to other substances: opioids. In May 2018, ScienceNews wrote an article about this exact topic. From 1999 to 2014, opioid use during pregnancy quadrupled: from 1.5 to 6.5 in every 1,000 births. This is significant and is even greater than the prevalence of FAS in the United States. It also happens to mirror the number of sales of prescription opioids; this number also quadrupled from 1999 to 2014. 

So what happens when a fetus is exposed to opioids?

Opioid use, particularly in the third trimester can cause pre-term birth or even stillbirth. In half of the fetuses exposed to opioids that are born, they go through opioid withdrawal — starting 24 to 72 hours after birth and lasting for 5 days. This is a major issue as 24,000 babies are born every year with opioid withdrawal, termed Neonatal Abstinence Syndrome. Symptoms include excessive crying, overexaggerated reflexes, and tremors. In the NICU, these newborns are given another, less addictive opioid like methadone, which is then reduced over time to reduce the symptoms of withdrawal.

What are the long term effects?

Unfortunately, we don’t really know for sure what the long term effects are since the increase in cases of Neonatal Abstinence Syndrome has skyrocketed in recent years. However, a study at Seattle Children’s Hospital has identified a few long term effects: middle ear infections, vision problems, motor development problems, behavioral and cognitive problems, and increased risk of drug use. There is much we do not know about the long term effects. Yet, we know this is something that deserves our attention.

What can we do to help?

Of course, we need better and more extensive public health efforts to rehabilitate opioid addicts and reduce the widespread prescription of opioids in doctor’s offices. Since the increase of children born exposed to opioids exactly mirrors the increase in prescription opioid sales, this could be a real root of the problem.

However, there are some ideas out there that would work much more quickly. Physicians at Yale are proposing that, instead of treating these newborns with opioids and just prolonging the time they are exposed to these most-likely harmful medications, it would be better to place the newborn in their parents’ arms and make sure they get the comfort they need.