Genetic mutations may protect infants born to drug-using mothers

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1. Single nucleotide polymorphisms in OPRM1 and COMT are associated with an increased risk of opioid addiction in adults. 

2.  Mutations in OPRM (118A>G) and COMT (158A>G) may be associated with a shorter length of stay in babies born with neonatal abstinence syndrome.  

Evidence Rating Level: 3 (Fair) 

Study Rundown: Neonatal abstinence syndrome (NAS) represents a group of symptoms that occur in newborns who are exposed to either illegal or prescription drugs in utero. 60% to 80% of infants born to mothers on methadone or buprenorphine will present with the symptoms of NAS. The range of symptoms depends on the type of drug used, the mother’s metabolism, amount of drug taken, and how long the drug was taken for. Body systems commonly affected include the nervous, gastrointestinal, and respiratory systems. This study primarily examined certain single nucleotide polymorphisms in the mother and infant, and the infant’s length of hospital stay in cases where the mother had documented methadone or buprenorphine use during the third trimester.

The study demonstrates that infants with single nucleotide polymorphisms (SNPs) in OPRM1 and COMT have a reduction in length of stay and amount of medical treatment required to treat NAS. Because this study represents the first to examine the association between SNPs and opioid withdrawal in infants, further research with larger populations and better criteria to evaluate NAS symptoms that may be subjectively biased is needed. Furthermore, the study population was rather homogenous with 98% white participants, and future studies should adopt populations with greater ethnic variability. The biological underpinnings underlying the observed differences from SNPs should also be better delineated. Nonetheless, this study provides a unique avenue or research with possible clinical implications in the future with further research.  .

Click to read the study, published today in JAMA

Relevant Reading: Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure

In-Depth [prospective study]: This study followed 86 mother-infant dyads, 51 from Tufts Medical Center affiliated sites and 35 from Eastern Maine Medical Center, between July 2011 and July 2012. Infants were enrolled at 36 weeks gestational age or older if they were exposed to maternal methadone or buprenorphine in utero for at least 30 days. The primary outcome was length of hospital stay. Infants with the OPRM1 (118A>G) AG or GG genotype had shorter length of stays and required less treatment than those with the AA genotype (17.6 days vs. 24.1 days; p=.009)

Infants with the COMT (118A>G) AG or GG genotype had shorter length of stays and required less treatment than those with the AA genotype (20.4 days vs. 31.1 days; p=.005).

By John Prendergass and Rif Rahman

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