The effect of prenatal alcohol co-exposure on neonatal abstinence syndrome in infants born to mothers in opioid maintenance treatment

Abstract

Objective: This study examined the effects of prenatal alcohol exposure (PAE) on the incidence and severity of neonatal abstinence syndrome (NAS).

Study design: For this pilot study, 70 pregnant women on opioid maintenance therapy (OMT) were recruited from a perinatal substance abuse clinic. Subjects were categorized into three study groups based on the timing of alcohol use during pregnancy as assessed by repeated self-reported measures and a comprehensive panel of ethanol biomarkers. NAS outcomes included: duration of hospital stay, the need for pharmacological treatment of NAS, newborn age at the initiation of NAS treatment, duration of treatment and cumulative methadone dose administered.

Results: The study included a large proportion of ethnic minorities (81.4% Hispanic, 5.7% American Indian), women with less than a high school education (52.2%) and unplanned pregnancy (82.9%). In multivariate analysis, PAE was not associated with NAS outcomes; however, one newborn diagnosed with fetal alcohol syndrome (FAS) demonstrated much more severe NAS compared to other PAE infants. Interestingly, 3rd trimester PAE was associated with a higher prevalence of microcephaly (62.5%) compared to the PAE abstaining group (36.8%; p = 0.08).

Conclusion: In this study, PAE was not associated with NAS severity; however, further examination in a larger study is needed.

• Alcohol
• methadone
• neonatal abstinence syndrome
• opioids
• pregnancy

Acknowledgements

This study was supported by research grants from the NIAAA/NIH (1R03AA020170-01; 1P20AA017608), NCRR/NIH (8UL1TR000041) and the Alcohol Beverage Medical Research Foundation (ABMRF). Drs. Bakhireva’s, Rayburn’s, and Leeman’s effort is partially supported by the R01 AA021771 grant from NIAAA/NIH.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

* Presented at the annual meeting of the American College of Clinical Pharmacy, Albuquerque, NM, 13–16 October 2013.