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Postpartum maternal opioid treatment associated with increased risk of adverse effects in infants

The risk of injury to newborns of mothers who used opioids after delivery, typically after cesarean section, is no greater than that of mothers who were not prescribed opioids. According to the researchers, these data should reassure health professionals and parents that there is little chance of harm to these infants.

Patients are often given opioids such as morphine and codeine shortly after surgery to treat pain. The risk that opioids in breast milk might pose to breastfed babies is still a matter of debate, despite the fact that all opioids pass into breast milk in amounts not expected to affect breastfed babies.

To address this uncertainty, researchers in Canada decided to investigate whether maternal opioid treatment after delivery is associated with an increased risk of adverse outcomes in infants.

They drew on eight years of health care data from 865,691 mother-child pairs who were discharged from an Ontario hospital within seven days of giving birth between September 1, 2012, and March 31, 2020.

After applying exclusions, 85,852 mothers filled an opioid prescription within seven days of discharge and 538,815 did not. Each mother who prescribed an opioid within seven days of discharge was matched to a mother who did not (control group).

The majority (81 percent) of mothers in the matched cohort delivered by caesarean section. Of mothers prescribed opioids, 42 percent received oxycodone, 20% codeine, 19% morphine, and 12% hydromorphone, with an average supply of 3 days.

The researchers then followed all infants for 30 days for a range of serious outcomes, including hospital readmissions, emergency room visits, neonatal intensive care unit admissions, and death from any cause.

After accounting for other potentially influential factors, including maternal age and medical history, the researchers found that of infants admitted to the hospital within 30 days, 2,962 (3.5%) were born to mothers who filled an opioid prescription, compared with 3,038. (3.5%) born to mothers who did not.

Infants of mothers who were prescribed an opioid were no more likely to be admitted to the hospital for any reason than infants of mothers who were not prescribed an opioid (absolute risk increase of 0.08 percent).

Infants of mothers prescribed an opioid were marginally more likely to be taken to the emergency room in the next 30 days (absolute risk increase of 0.41 percent), but no differences were found in other serious infant outcomes, including breathing problems or admission to a neonatal intensive care unit and there were no infant deaths.

This is an observational study, so causation cannot be determined, and the researchers acknowledge several limitations, such as a lack of information on the extent to which medications were used, use of other over-the-counter pain medications, and breastfeeding status. What’s more, they cannot rule out the possibility that some other, unmeasured factors may have influenced their results.

However, they point out that the initial rate of breastfeeding in Canada is very high (90 percent), which lends more confidence to their conclusions. The findings are also consistent with the fact that millions of new mothers are prescribed opioids each year after giving birth, yet no conclusive reports of severe opioid toxicity in infants associated with breastfeeding have been published.

They concluded: “Findings from this study suggest no association between postpartum maternal opioid prescribing and adverse infant outcomes, including death.”

Written by: Vaishali Verma

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