approach has not been shown to be effective and may deter women from seeking
As the number
of pregnant women who use opioids has increased over the past decade, more
infants have been born experiencing withdrawal symptoms, a national trend that
requires a public health response rather than a punitive approach, according to
a new policy statement released by the American Academy of Pediatrics (AAP).
state governments have prosecuted and jailed the mothers for substance use, the
punitive measures provide no proven health benefits for mother or child -- and
may lead to avoidance of prenatal care and substance use treatment, according
to the report. The policy statement, “A Public Health Response to Opioid Use in Pregnancy,
” will be published in the March 2017 issue of Pediatrics (online Feb. 20).
“Over the last
two decades, use of opioids surged throughout the U.S., and as they did, we
have seen an increase in opioid-related complications in nearly every
population, including pregnant women and their infants,” said Stephen Patrick,
MD, MPH, MS, FAAP, a co-author of the report.
should be grounded in public health. We should be bolstering efforts targeted
at primary prevention, like prescription drug-monitoring programs, and
expanding treatment tailored to the specific needs of pregnant women and their
The rate of
infants born experiencing withdrawal symptoms, a condition known as neonatal
abstinence syndrome, has grown nearly fivefold over the last decade, and, by
2012, accounted for an estimated $1.5 billion in hospital charges, according to
research. In 2012, one infant was born every 25 minutes with the condition
nationwide – prompting attention from the public, providers and policymakers.
improving access to contraceptives, prenatal care and treatment for substance
use disorder, the Academy recommends:
routine screening for alcohol and other drug use in women of childbearing
information and obtaining informed consent for maternal drug testing and
access to comprehensive obstetric care, including opioid-replacement
treatment programs specifically designed for pregnant women
funding for social services and child welfare systems
comprehensive prenatal care and treatment for women with substance use
disorders is associated with fewer preterm deliveries,
small-for-gestational-age infants, and infants with low birth weight. Studies
indicate that pregnancy can motivate women with substance use disorders to seek
treatment; however, there remains a dearth of comprehensive treatment programs
geared toward pregnant and parenting women.
The AAP first
published recommendations on substance-exposed infants in 1990, calling for
non-punitive access to comprehensive care for pregnant women and their infants.
Since then, more than 20 national organizations have published similar
statements. Despite the strong consensus from the medical and public health
community, there has been an increase in the number of states approving and
considering criminal prosecution laws for pregnant women with substance use
must be able to discuss their substance use openly with their medical providers
without fear of punishment,” said co-author Davida M. Schiff, MD, FAAP.
“Punitive policies towards pregnant women with substance use disorder are
detrimental to the health of mother and baby.”
American Academy of Pediatrics is an organization of 66,000 primary
care pediatricians, pediatric medical subspecialists and pediatric
surgical specialists dedicated to the health, safety and well-being of
infants, children, adolescents and young adults. For more information,
and follow us on Twitter @AmerAcadPeds.