300 Determining the impact of co-exposure of tobacco on opioid exposed pregnancies

Abstract

Neonatal opioid withdrawal syndrome (NOWS) is a phenomenon where infants exhibit withdrawal symptoms due to intrauterine opioid exposure. Research suggests a more severe presentation of NOWS is associated with concurrent substance use disorders. In this study we aim to explore the relationship between NOWS severity and co-exposure to tobacco in opioid exposed pregnancies. This is a retrospective cohort study from 2014-2019 at a single tertiary care center. Pregnant women ≥ age 18 with non-anomalous fetuses on maintenance Methadone or Buprenorphine with gestational age ≥33 weeks were included. Cigarette smoking status was determined by chart review. Severe NOWS requiring opioid treatment was defined by 3 consecutive Finnegan scores ≥8 or the sum of 3 consecutive Finnegan scores ≥24 within 72 hours of birth. Data was analyzed using descriptive, parametric and non-parametric statistics. A p-value of <0.05 was considered significant. There were 110 opioid exposed neonates included in this analysis with a mean gestational age of 37 weeks. Within the cohort 55% (61/110) were exposed to Methadone and 45% (49/110) were exposed to Buprenorphine. Of the 46% (51/110) of infants with severe NOWS, 69% (35/51) were Methadone exposed and 31% (16/51) were Buprenorphine exposed (p =0.01). The majority of mothers smoked, 87% (96/110), with 90% (46/51) of infants with severe NOWS being exposed to tobacco compared to 85% (50/59) in the non-severe group (p=0.39). Packs per day (PPD) were also similar between groups (0.46 PPD non-severe NOWS vs 0.55 PPD severe NOWS, p=0.21). However, opioid-exposed infants with heavy smoking (>1PPD) mothers were more likely to develop severe NOWS (p=0.04) and had higher peak Finnegan scores (p<0.01). Heavy smoking (>1PPD) increases the risk of severe NOWS in opioid exposed neonates. Smoking reduction and cessation should be recommended in pregnant women on opioid maintenance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)