Tens of thousands of newborns suffer from drug withdrawal each year, due partly to the sheer number of opioid painkillers and antidepressants that doctors prescribe for pregnant women, a new study suggests. Researchers examined data from more than 200,000 women and found that those who had taken both prescription painkillers and antidepressants were significantly more likely to give birth to newborns that were dependent on narcotics.

“Late pregnancy exposure to both opioids and certain psychotropic medications—in particular benzodiazepines, antidepressants, and gabapentin—increases the risk of neonatal drug withdrawal in the newborn by 30 to 60 percent,” coauthor on the study Krista F. Huybrechts of Brigham and Women’s Hospital and Harvard Medical School told Fatherly. “Exposure to two or more psychotropic medications in addition to prescription opioids doubles the risk.”

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Opioid prescriptions are spiraling out of control. Prescriptions in the United States have tripled since the 1990s, and studies suggest roughly 20 percent of pregnancies in the U.S. are complicated by exposure to prescription opioids, such as OxyContin, Vicodin, and morphine. The crisis has caused widespread addiction and death, but one of the lesser known consequences is the spike in neonatal abstinence syndrome—newborns born dependent on drugs, absorbed from their mothers during pregnancy. Both illegal drug users and those taking prescription drugs are at risk. One infant is born with signs of drug withdrawal every 25 minutes.

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And the effects can be torturous. “Symptoms of neonatal drug withdrawal range from feeding and sleeping difficulties, to more severe complications including impaired thermoregulation, seizures, failure to thrive, and respiratory distress,” Huybrechts says. Much like adults who are being weaned off narcotics, the only course of therapy for these children is to prescribe the infant a drug similar to the on the mother used during pregnancy and taper it off over time.

And it isn’t just opioids. Recent evidence suggests that pregnant women who take antidepressants are also at risk of giving birth to newborns in withdrawal. To examine the link between painkillers, antidepressants, and neonatal abstinence syndrome, Huybrechts and colleagues examined data from 201,275 pregnant women, obtained through Medicaid. After controlling for a number of variables, they found that women exposed to any prescription opioid had a 1 percent risk, but that exposure to any psychotropic medication increased the risk. Gabapentin, an anti-seizure medication also used to treat nerve pain, had one of the most pronounced effects, bumping the risk of neonatal abstinence syndrome up to 11.4 percent.

“Both medication classes—opioids and psychotropics—had independently been associated with withdrawal symptoms,” Huybrechts says. “Our study confirms that exposure to both medication classes at the same time does indeed increase the risk of withdrawal. We were also able to examine differences in the magnitude of the risk by specific psychotropic medication.”

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The study, which was observational, has its flaws. But independent experts maintain that it represents a crucial step toward understanding how medications given during pregnancy can impact a newborn. “These data were derived from hospital administrative records, which can be prone to misclassification bias and cannot account for illicit co-exposures (such as cocaine),” cautions Stephen Patrick of Vanderbilt University, in an editorial on the study. “Nevertheless, the data are unique providing the power to detect rare outcomes, and these findings are important in targeting prevention efforts and potentially in tailoring treatment of opioid exposed infants.”

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That doesn’t mean pregnant women all need to avoid painkillers and antidepressants. In fact Heybrucht stresses that, for some at-risk women, the drug-free alternative can be far worse than neonatal abstinence syndrome. Women who need antidepressants, for instance, may be at higher risk of suicide if they choose not to take their medications to protect their fetuses. And since pain and mental health conditions often go hand-in-hand, prescribing opioids along with antipsychotics and antidepressants may be unavoidable in some cases.

“All treatment decisions during pregnancy require the physician and the pregnant woman to balance potential benefits and risks to both the mother and the newborn,” Huybrechts says. “Our study suggests that clinicians should be cautious in prescribing these medications together in late pregnancy and in prescribing psychotropic medications to women with known or suspected illicit opioid use. It will be important for neonatologists and pediatricians to rethink treatment protocols for infants born to women who were prescribed multiple drugs during their pregnancy.”