Fetal Opioid Exposure and Risk for Neural Anomalies

Eleanor Bimla Schwarz, MD, MS

Maternal opioid use during early pregnancy was associated with neural tube defects.

Although opioid medications are FDA pregnancy class D, their use by U.S. women has been increasing, with an estimated 20% of pregnant women reporting first-trimester opioid use in 2009. Maternal therapeutic opioid use has been associated with excess risk for heart defects and spina bifida (NEJM JW Womens Health Apr 7 2011). Now, using case-control data collected from 1998 through 2010 from mothers interviewed within 6 months of delivering babies with neural tube defects (305), other malformations (13,405), or no malformations (7125), investigators examined whether maternal opioid use is associated with risk for neural tube defects.

Mothers of babies with neural tube defects — particularly spina bifida — were more likely to report using an opioid medication during the first 2 months of pregnancy than were mothers of babies with other malformations or no malformation. The prevalence of neural tube defects among offspring of mothers who used opioids was estimated to be 6 per 10,000 live births.

Citation(s):

Yazdy MM et al. Periconceptional use of opioids and the risk of neural tube defects. Obstet Gynecol 2013 Oct; 122:838.