Neonatal abstinence syndrome

As the global prevalence of opioid use has alarmingly increased, so has the incidence of neonatal opioid withdrawal syndrome (NOWS), which is associated with multiple maternal and neonatal factors. Although rarely fatal, newborn withdrawal can be associated with substantial morbidities in the first weeks of life if not properly managed.

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When we invited the authors to write a Primer on neonatal abstinence syndrome, we wanted a comprehensive article that discussed all of the issues at hand, including a description of placental biodisposition of substances, how the placental transfer of the metabolites affects the developing foetus and the immediate effects that the cessation of prenatal exposure to such substances might have on the neonate, as well as the long-term effects that this exposure might have on the child. 

Several substances assumed by a pregnant woman can affect the child, but opioids are particularly dangerous as they readily pass through the placenta into the foetal circulation. Thus, the Primer focuses on neonatal abstinence syndrome caused by opioid use during pregnancy — neonatal opioid withdrawal syndrome (NOWS). Importantly, we also wanted the article to discuss the efforts and challenges to identify pregnant women who take opioids (whether or not under medical supervision), whose babies are at risk of developing NOWS, and the prenatal and substance use care these women need. 

In this Primer, Coyle et al. have delivered all of this and more, with great clarity and accuracy. As the prevalence of opioid use, misuse, dependence and addiction continues to grow, the authors highlight the complexities (social and medical) of treating pregnant women with opioid dependence or addiction and stress the importance of supporting women during and after pregnancy to ensure optimal outcomes for the mother–child dyad.

By Lucia Brunello, Nature Reviews Disease Primer


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