Surgery before pregnancy linked to higher risk of opioid withdrawal in babies

Babies whose mothers underwent surgery before pregnancy have an increased risk of opioid withdrawal symptoms at birth.

Babies whose mothers underwent surgery before pregnancy have an increased risk of opioid withdrawal symptoms at birth.

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Use of opioids to control post-op pain can also lead to dependency, an UdeM study finds.

Nathalie Auger

Babies whose mothers underwent surgery before pregnancy have an increased risk of opioid withdrawal symptoms at birth, according to a new study done at the University of Montreal Hospital Research Centre (CRCHUM) and published in the Canadian Medical Association Journal.

"Use of opioids for pain control after surgery may increase the risk of opioid dependence in women and withdrawal in their newborns," said the study's lead author Dr. Nathalie Auger, a professor at the University of Montreal’s School of Public Health.

"We found that mothers who had surgery before pregnancy had 1.6 times the risk of neonatal abstinence syndrome – that is, opioid withdrawal symptoms in their future newborns – perhaps because opioid use continues after surgery."

The large study included data on almost 2.2 million births in Quebec between 1989 and 2016. Of those, 2,346 newborns had neonatal abstinence syndrome and, of these, 1,052 had mothers who underwent prepregnancy surgery (14.9 per 10,000 babies) compared with 1,294 babies (8.8 per 10,000) born to mothers who did not have surgery.

Multiple surgeries, younger age at surgery, longer time between surgery and pregnancy,  and cardiovascular, thoracic, urologic, or neurosurgery were associated with the largest risk of neonatal abstinence syndrome. There was also a strong association with general anesthesia, perhaps because this type of anesthesia is used in more complex surgeries, which can require longer use and higher dosage of pain relievers.

"Physicians have the potential to prevent neonatal abstinence syndrome with careful postoperative pain management in young women," Auger said. "Opioids continue to be overprescribed, despite efforts made to optimize postsurgical pain control through improvement of surgical guidelines and use of multipronged approaches with nonopioid painkillers or local anesthetics."

Limiting postoperative opioid exposure, reducing overprescribing and screening for opioid use in pregnant women who have had previous surgery may help reduce the risk of neonatal abstinence syndrome, she added.

About this study

"Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study," by Nathalie Auger et al, was published July 15, 2019 in the Canadian Medical Association Journal.

About the CRCHUM

The Université de Montréal Hospital Research Centre (CRCHUM) improves the health of adults through a high-quality academic research continuum which, by improving our understanding of etiological and pathogenic mechanisms, fosters the development, implementation, and assessment of new preventive, diagnostic and therapeutic strategies. The CRCHUM provides a training environment to ensure the development of new generations of researchers committed to research excellence. 

Media contact

  • Lucie Dufresne
    Centre hospitalier de l’Université de Montréal
    Tel: 514 890-8000 p. 15380
  • Jeff Heinrich
    Université de Montréal
    Tel: 514 343-7593