Depression, Anxiety, and Stress in Women Misusing Opioids During Pregnancy and Effects on the Development of Neonatal Opioid Withdrawal Syndrome

Anxious and depressive disorders are prevalent among women who misuse opioids during pregnancy. Furthermore, these disorders have been linked to the development of neonatal opioid withdrawal syndrome (NOWS) in infants exposed to opioids in-utero. The role of stress in pregnancy among women misusing opioids remains to be understood, however, despite its relevance to anxiety, depression, and substance use. The present study aimed to expand upon current research by comparing symptoms of anxiety, depression, and stress in a sample of women who misused opioids during pregnancy (n = 53) and women with high-risk pregnancies for reasons unrelated to drug use (e.g., obesity, heart/blood disease; n = 37). This study additionally examined whether depression, anxiety, and stress symptoms during pregnancy predicted whether infants were born with NOWS. Findings revealed significantly higher depression, anxiety, and stress among pregnant women who misused opioids than among pregnant women with high-risk pregnancies unrelated to drug use. Furthermore, results indicated that higher anxious symptoms and lower stress symptoms contributed to a greater likelihood of infants developing NOWS after delivery. Post hoc analyses revealed that stress and anxious symptoms only emerged as significant predictors of NOWS within the group of women who tapered to lower doses of opioids prior to delivery. Conversely, symptoms of depression, anxiety, and stress did not significantly predict NOWS within the group of women who maintained a stable, prescribed dose of opioids throughout pregnancy or within women who completely detoxified from opioids by the time they gave birth, as there was little to no variability within these groups. Clinical implications, future directions, and limitations of the present study are discussed.