NU631 Healthcare of Women across the life span -Peer Review week 12

Please respond to at least 2 of your peer’s posts.  To ensure that your responses are substantive, use at least two of these prompts:

  • Do you agree with your peers’ assessment?
  • Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
  • Share your thoughts on how you support their opinion and explain why.
  • Present new references that support your opinions.

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.


1- Amanda Olazabal

What is the accepted name of the condition with which the child will be born?

Neonatal abstinence syndrome (NAS) is a withdrawal syndrome of infants born to women who use or misuse opioids during pregnancy which occurs shortly after birth (Jansson & Patrick, 2019).  It can vary in symptoms and intensity, depending on which medications or drugs the mother has exposed the fetus to, what stage of the pregnancy the fetus was exposed to opioids, and any comorbid conditions of the child (Jansson & Patrick, 2019).  Often there is polysubstance abuse in these situations (Jansson & Patrick, 2019).  The most common way this condition is identified is with meconium testing for drugs, though urine and hair can also be tested (Anbalagan & Mendez, 2023)


What are the peri-natal risks to the infant?

Opiod exposure during pregnancy is correlated with poorer access to prenatal care (The American College of Obstetricians and Gynecologists [ACOG], 2012).  Complications which can occur prior to delivery can include intrauterine growth restriction or placental abruption (ACOG, 2012).  Preterm labor and birth and fetal death can also be associated with opioid use disorder (OUD) in pregnancy (ACOG, 2012).  Another concern is the exposures that are related to other behaviors of the mother to support her addiction, including criminal activity and prostitution, or high-risk sexual encounters (ACOG, 2012). 


What are the post-natal risks to the infant?

After birth, neonatal abstinence syndrome is common in babies born to mothers who have opioid addiction (ACOG, 2012).  Their symptoms can be categorized into problems with attention, motor control and tone, sensory, and autonomic functioning (Jansson & Patrick, 2019).  These babies are often irritable, have poor sleep, impaired suck reflexes which results in difficulty with feeding the child (ACOG, 2012).  Further complicating feeding include the gastrointestinal symptoms of withdrawal, including vomiting, diarrhea, and reflux (Anbalagan & Mendez, 2023).  Autonomic dysfunction is expressed as rapid heart rate, rapid breathing, and unstable maintenance of body temperature (Anbalagan & Mendez, 2023).  Children with NAS are at higher risks for infection and sepsis, which can sometimes overlap the symptoms of NAS (Jansson & Patrick, 2019).  Additionally, because of the risk of pre-term labor, the complications of prematurity may also be conferred (Jansson & Patrick, 2019).  These babies have a higher chance of being small for gestational age (Azuine et al., 2019).  A prolonged hospital stay after birth is likely (Azuine et al., 2019).  Other complications in the immediate post-natal include low blood sugar, hypocalcemia and brain injuries or stroke (Jansson & Patrick, 2019).  In rare occurrences, a neonate may have a seizure from withdrawal, though this has been confused with the common myoclonic jerks seen in NAS (Anbalagan & Mendez, 2023; Jansson & Patrick, 2019). 


What are the post-natal risks to the mother?

Mothers with opioid use disorder have higher incidences of medical, psychiatric, and social complications.  There is an increased risk of gestational diabetes and maternal death (Azuine et al., 2019).  These women often have behavioral health comorbidities such as anxiety, PTSD and depression (ACOG, 2012).  She is at risk after the delivery of having her child placed in child protective custody or incarceration (ACOG, 2012). 


Is there any evidence on the long-term risk to the child?

Long term outcomes are difficult to study, particularly because of the common exposure to multiple substances and other social determinants of health (ACOG, 2012).  There is correlation of behavioral disorders, emotional disorders, and poorer psychological development in preschool- and school-aged children identified in one study of over 8500 infants born to mothers with addiction, 454 were of opioid addiction (Azuine et al., 2019).  Some studies have identified that children will show lower IQ scores and executive functioning in the future (Anbalagan & Mendez, 2023).  Behavioral and conduct disorders are more commonly diagnosed in these children than the population average (Anbalagan & Mendez, 2023). 


2- Dhara Patel

What is the accepted name of the condition with which the child will be born?

Given this woman’s history of drug use in pregnancy, the child will be born with a condition called Neonatal Abstinence Syndrome (NAS), which is a spectrum of clinical manifestations commonly seen in neonates due to withdrawal from intrauterine drug exposure (Anbalagan & Mendez, 2023). Evidence has shown that all infants born to a woman who has used substances during their pregnancy are at risk for NAS, but not all infants will have NAS (MN Department of Health, 2023). It is estimated that between 55% and 94% of newborns whose mothers used opioids consistently while pregnant will develop this condition (MN Department of Health, 2023). The predominant symptoms include central nervous system, gastrointestinal, and autonomic manifestations (Anbalagan & Mendez, 2023). There is often a triad of increased muscle tone, tremors when undisturbed, and an exaggerated Moro reflex (Anbalagan & Mendez, 2023). Other initial presenting symptoms include excessive high-pitched crying, irritability, sneezing, and diarrhea, all of which are due to an increased noradrenergic state (Anbalagan & Mendez, 2023). 

What are the peri-natal risks to the infant?

Research has shown that infants exposed to opioids in utero are at an increased risk for preterm birth and stillbirth, hypoxia, low mental and psychomotor development, language and reading deficits, low cognitive development and functioning, lower IQ score, and neurodevelopmental impairment (Azuine et al., 2019). 

What are the post-natal risks to the infant?

Some of the risks include low birth weight, jaundice, seizures, and sudden infant death syndrome (March of Dimes, 2019). Recent evidence has also shown that children exposed to opioids have a higher percentage of diagnoses of conduct disorder/emotional disturbance, lack of expected normal physiological development, and higher risk of developing ADHD (Azuine et al., 2019).

What are the post-natal risks to the mother?

Mothers with opioid use disorder (either current or during pregnancy) often suffer from co-occurring mental health conditions, such as depression, a history of trauma, posttraumatic stress disorder, and anxiety (The American College of Obstetricians and Gynecologists, 2021). Given her current situation of being a single parent with no support from the father of her child or her own parents, she is also at an increased risk of developing post-partum depression. Research has found that a previous history of depression or psychiatric illness, depressive symptoms during pregnancy, and a lack of spousal and social support were the most powerful risk factors for developing postpartum depression (Agrawal et al., 2022), which this patient has based on the given scenario. Also, research has shown that women who are addicted to opioids are also at an increased risk of use of other substances, including tobacco, marijuana, and cocaine (The American College of Obstetricians and Gynecologists, 2021). This woman may also suffer from poor nutrition leading to negative health for herself and her child.

Is there any evidence of the long-term risk to the child? 

Some evidence has found that the neonatal abstinence syndrome can cause long-term problems for the child including developmental delays, motor problems affecting the muscles, bones, and their movement, behavior, and learning problems, speech and language problems, sleep problems, ear infections and vision problems (March of Dimes, 2019). 

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