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Increased Severity of Neonatal Abstinence Syndrome Associated With Concomitant Antenatal Opioid and Benzodiazepine

Lauren A Sanlorenzo1,2,3, William O Cooper4,3,5, Judith A Dudley5

  • 1Departments of Pediatrics and lauren.a.sanlorenzo@vumc.org.

Hospital Pediatrics
|July 3, 2019
PubMed

Insights

Benzodiazepine exposure during pregnancy increases the risk of infants developing pharmacologically treated neonatal abstinence syndrome (NAS). This finding aids in identifying high-risk infants for personalized care plans.

Area of Science:

  • Neonatal Abstinence Syndrome (NAS) research
  • Maternal and infant health
  • Pharmacotherapy outcomes

Background:

  • Polysubstance use is common in pregnant women using opioids.
  • The link between polysubstance use and neonatal abstinence syndrome (NAS) pharmacotherapy is not well understood.
  • Benzodiazepine exposure was hypothesized to elevate the risk of pharmacologically treated NAS.

Purpose of the Study:

  • To investigate the association between antenatal exposures and pharmacologically treated neonatal abstinence syndrome (NAS).
  • To determine if benzodiazepine exposure increases the risk of NAS requiring pharmacotherapy.
  • To identify other antenatal exposures not associated with increased risk of pharmacologically treated NAS.

Main Methods:

  • Retrospective cohort study of maternal-infant dyads using Tennessee Medicaid data (2009-2011).
  • Individual-level data linkage including vital records and administrative data.
  • Chart review for clinical exposure data and multivariable logistic regression analysis.

Main Results:

  • Of 822 confirmed NAS cases, 72.7% received pharmacotherapy.
  • Infants exposed to antenatal benzodiazepines had a higher likelihood of pharmacologically treated NAS (40.9% vs. 30.8%).
  • Benzodiazepine exposure was independently associated with an increased risk of pharmacologically treated NAS (OR: 1.51).

Conclusions:

  • Antenatal benzodiazepine exposure is an independent predictor of pharmacologically treated NAS in infants with intrauterine polysubstance exposure.
  • Identifying antenatal benzodiazepine exposure can aid in risk stratification for opioid-exposed infants.
  • Personalized care plans can be developed based on antenatal benzodiazepine exposure history.
Abstract

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