The opioid epidemic in the United States touches nearly everyone in our society. NICHD is committed to understanding how these drugs affect infants, children, and pregnant and reproductive-age women. The institute is supporting multiple research activities related to opioids, in keeping with NIH's overall efforts to find scientific solutions to the opioid epidemic. We describe some of NICHD's efforts on this page.
Research on Pregnant and Reproductive-Age Women
Pain is a common feature of many gynecological conditions, such as endometriosis, pelvic adhesions, and pelvic inflammatory disease. Pelvic surgery, such as Cesarean delivery or laparoscopy, and childbirth-related pain are also common reasons for reproductive-age women to be prescribed opioids. Treating obstetric and gynecologic pain can mean long-term exposure to opioids, which places women—including pregnant women—at risk for opioid use disorder.
To learn more about opioid misuse during pregnancy, NICHD held a workshop in 2016, where experts identified research gaps and opportunities to improve outcomes for families. Key findings included:
- Routine screening for substance use, including misuse of prescription opioids, should be offered to all women throughout pregnancy.
- Reducing unnecessary opioid use in healthy women after delivery is an important goal for preventing future opioid misuse.
- More research is needed to understand how best to screen and treat pregnant women for opioid use disorder and to understand additional problems, such as poor nutrition and mental illness, that can accompany opioid use disorder in pregnancy.
- Research also is needed to develop non-opioid pain medications that are tested for safety and efficacy in pregnant or breastfeeding women.
The following video explains more details from the workshop. You can also read more at NIH-led workshop addresses opioid misuse during pregnancy.
In 2017, NICHD and the National Institute of Drug Abuse (NIDA) sought research projects related to the following topics:
- Clinical studies of medically supervised opioid withdrawal that evaluate potential outcomes such as maternal complications, fetal complications, pregnancy loss, and neonatal opioid withdrawal syndrome.
- Pharmacokinetic and pharmacodynamic studies to optimize management of medications used to treat opioid use disorder in pregnant and/or postpartum women.
- Observational or cohort studies evaluating the effects of medication-assisted opioid cessation (such as methadone) on maternal, fetal, and neonatal outcomes.
- Studies of genetic and/or epigenetic factors associated with the effects of opioid use during pregnancy on fetal and neonatal outcomes.
Research on Neonatal Opioid Withdrawal Syndrome (NOWS)
Newborns who are exposed to opioids while in the womb are at risk for withdrawal symptoms after birth, called NOWS or sometimes Neonatal Abstinence Syndrome (NAS). Symptoms of NOWS often include tremors, excessive crying and irritability, and problems with sleeping, feeding, and breathing. Although NOWS is known to increase the risk for neurodevelopmental problems as infants grow older, little is known about its long-term effects. There is also no standard evidence-based treatment for NOWS in the United States, even though the number of reported cases is higher than in recent years.
Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW)
The effort, launched in 2017, aims to inform clinical care of infants who are exposed to opioids in the womb. ACT NOW receives support from:
- NICHD, through its Neonatal Research Network, which has more than 30 years of experience designing and implementing clinical trials involving infants
- NIH Office of the Director's Environmental influences on Child Health Outcomes (ECHO) Program, including the Institutional Development Award (IDeA) States Pediatric Clinical Trials Network, which focuses on rural and medically underserved communities, including those reporting a higher incidence of NOWS
ACT NOW pilot studies assessed the prevalence of NOWS across more than 20 research hospitals and surveyed current management approaches in preparation for developing research protocols for large-scale studies.
NICHD and ECHO are planning a set of clinical trials that will provide evidence for the clinical care of NOWS infants to help inform medical practice and health policy.
NIH-funded study to focus on newborns affected by opioids provides details about the effort.
NIH Helping to End Addiction Long-termSM (HEAL) Initiative
NICHD is actively involved with the NIH HEAL InitiativeSM, an aggressive, trans-agency effort launched in April 2018 to speed scientific solutions to stem the national opioid crisis. The initiative builds on established NIH research and networks, such as ACT NOW, and includes plans to integrate behavioral interventions with medication-assisted treatment for opioid use disorder. Learn more on the NIH HEAL Initiative website.
Research Funding Information
- NICHD seeks applications to study effects of maternal opioid use on newborns
- NIH leadership outlines interdisciplinary FY2018 research plan for HEAL Initiative
- NIH launches HEAL Initiative, doubles funding to accelerate scientific solutions to stem national opioid epidemic
- Spotlight: Selected NICHD Research Advances of 2017
- NIH-funded study to focus on newborns affected by opioids
- NIH-led workshop addresses opioid misuse during pregnancy
- NIH-led task force to address research needs of pregnant women and nursing mothers
- NIH HEAL InitiativeSM website
- National Institute of Drug Abuse
- Centers for Disease Control and Prevention (CDC)
- American College of Obstetricians and Gynecologists
- American Academy of Pediatrics
- Indian Health Service: Neonatal Opioid Withdrawal Syndrome