J Compr Ped. 2014 February; 4(1): e14779. Published online 2014 February 10. Research Article A Case-Control Study on Perinatal Outcomes of Opium-Addicted Pregnant Women and Their Offsprings in Rafsanjan, Iran Reza Derakhshan 1 ; Shahla Roodpeyma 2,* ; Parisa Balaee 1 ; Hamid Bakhshi 1 1 Department of Pediatrics, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran 2 Department of Pediatric Cardiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran *Corresponding author: Shahla Roodpeyma, Department of Pediatric Cardiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98- 2122074087, Fax: +98-2122074101, E-mail: roodpeyma_shahla@yahoo.com Received: September 10, 2013; Revised: October 5, 2013; Accepted: December 25, 2013 Background: Substance abuse during pregnancy leads to considerable adverse effects in mothers and their infants. Objectives: The purpose of this study was to evaluate perinatal complications in opium-addicted mothers and their newborns, exposed to opium in utero. Patients and Methods: During a one-year period (2008 - 2009), 45 opium-addicted mothers and their newborns were enrolled in a case- control study in Niknafs maternity hospital, Iran. Maternal drug usage was determined via self-reporting during structured interviews. Neonates with in-utero opium exposure were assessed and treated for neonatal abstinence syndrome (NAS). Demographic characteristics and perinatal complications for case and control subjects were obtained from medical records. Results: All cases were addicted to inhaled opium and none received methadone therapy. None of the cases was a heavy cigarette smoker, consumed alcohol, or had positive serology result for sexually-transmitted diseases. The mean ages were similar in both case and control groups. There was a higher prevalence of opium addiction among spouses of the case group subjects compared with the control group (P = 0.001). The case group had significantly lower education level (P = 0.01) and socioeconomic status (P = 0.001) compared to the control group. Low birth weight (LBW) was more frequent in the opium-exposed neonates compared with the control group neonates (P = 0.001). In the opium-exposed infants, signs of NAS were found in 32 (71%), requiring pharmacotherapy in 25 (55%) cases. Conclusions: Opium addiction among Iranian pregnant women is associated with an increased frequency of LBW in newborns. Furthermore, approximately half of the newborns exposed to opium in utero require pharmacotherapy for NAS. These findings support the need for comprehensive multidisciplinary evidence-based interventions in at-risk population. Keywords: Opium; Offspring; Pregnancy Implication for health policy/practice/research/medical education: Drug abuse during pregnancy poses serious adverse effects on both mothers and their fetuses. This article discusses the side effects of the most common illicit-substance abuse in Iran i.e. opium among a group of pregnant women. Copyright © 2014, Iranian Society of Pediatrics; Published by Safnek. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Background Pregnancy is defined as high risk, in illicit-drug-user women, as it is associated with medical problems in both the mother and the newborn. These women have a high- er incidence of sexually-transmitted infections including syphilis, HIV infection and hepatitis; they also usually have inadequate prenatal care (1-3). Risks of preterm la- bor, intrauterine growth retardation, premature rupture of membrane (PROM), as well as perinatal morbidity and mortality are higher in a drug-abuser pregnant woman (4-6). Illicit drug usage is often associated with multiple social, psychosocial, behavioral, and medical risk factors, including poverty, stress, depression, lack of social sup- port, physical abuse, household violence, and poor nutri- tion (2, 6-8). The abovementioned comorbidities, present in most illicit drug abusers, are among the factors that make it difficult to determine a cause-and-effect relation- ship between abuse of a drug and its maternal and neo- natal outcomes. Physical dependence to narcotics occurs in most infants born to current drug-abuser mothers, because of placen- tal transfer of opiates. Intrauterine opiate exposure is associated with neonatal abstinence syndrome (NAS), shortly after birth (9). Withdrawal symptoms usually occur 4 - 6 hours following the last opioid exposure and reach the peak in 48 - 72 hours (10). Among neonates who have had intrauterine exposure to opiates, 55% - 94% will experience some degrees of NAS (9). About 3/4 of new- borns with NAS require pharmacological therapy (11). Approximately 40% of exposed neonates are admitted to neonatology units for treatment of NAS, 30% of which are for conditions related to prematurity or low birth weight (LBW) (12). Most studies of prenatal opiate, heroin or methadone usage, show increased rates of LBW, preterm birth, and reduced fetal growth parameters; however, few have investigated the associated risk factors. Rates of neonatal hyperbilirubinemia and respiratory distress