Pregnant women misusing opioids: Depression, anxiety, stress, and neonatal opioid withdrawal syndrome

Abstract

• Pregnant women misusing opioids report significant depression, anxiety, and stress. • Symptoms are higher compared to women with other medically high-risk pregnancies. • High maternal anxiety and low stress predict neonatal opioid withdrawal syndrome. Diagnoses of anxiety and depressive disorders are prevalent among women who misuse opioids during pregnancy and have been linked to the development of neonatal opioid withdrawal syndrome (NOWS) in infants. The role of stress in NOWS, however, has not been studied, despite its relationship to anxiety and depression. Moreover, anxiety and depression have only been assessed at the level of diagnoses, limiting our understanding of the effects of symptoms along a continuum of severity on opioid misuse in pregnancy and NOWS. We first compared symptoms of anxiety, depression, and stress assessed along a continuum in women who misused opioids during pregnancy ( n = 53) who chose to receive medication assisted treatment (MAT) or to detoxify from opioids, and women with high-risk pregnancies for medical reasons unrelated to drug use ( n = 37). We then examined whether depression, anxiety, and stress symptoms during pregnancy predicted NOWS. Findings revealed significantly higher depression, anxiety, and stress among pregnant women who misused opioids than among the comparison group. Furthermore, results indicated that higher anxious symptoms as hypothesized (but not depressive symptoms), and lower stress symptoms contributed to a greater likelihood of infants developing NOWS after delivery beyond the type of treatment (i.e., MAT or tapering/detoxification) they received for opioid use. The present study used a small sample size and had some measurement limitations. Findings suggest important opportunities for effective integrated psychological and medical interventions for pregnant women misusing opioids to improve their own health and that of their infants.