Doctors have described a constellation of birth defects, including bandaged toes and bent feet, as a result of expectant mothers’ use of fentanyl during pregnancy.
The Delaware-based pediatricians have identified 10 babies with the defects in their state, as well as in California, Boston and Rhode Island, who are believed to have fetal fentanyl syndrome.
Their report is the first to reveal a link between the deadly street drug fentanyl, now widely used across the country, and these birth defects, which may be due to the fact that patients often conceal their history of drug use.
In addition to causing bandaged fingers and bent “rocking feet” – named for the way bent feet resemble the legs of a rocking chair – fetal fentanyl syndrome can also lead to a cleft palate, an abnormally small head, and neurological and behavioral problems, which last into adolescence.
The babies found to be affected by maternal use of fentanyl had smaller heads overall and underdeveloped jawbones
Some of the babies not only had underdeveloped jaws, but also cleft palates
Fentanyl has impacted millions of lives, and pregnant women are no exception. Deaths caused by the drug, which is 50 times more powerful than heroin, more than tripled from 2016 to 2021, rising from 5.7 per 100,000 people in 2016 to 21.6 in 2021.
More evidence is needed to prove beyond a reasonable doubt that fentanyl is the cause of these birth defects, which is not yet established scientific fact. For example, just two years ago, the National Institutes of Health said, “Based on the studies reviewed, exposure to fentanyl is not expected to increase the risk of birth defects above background risk.”
But researchers from Nemours Children’s Hospital in Delaware, who authored the latest study, said their “striking” discovery of a common denominator between all 10 babies was compelling.
They said: “No common genetic or genomic abnormality was identified, but prenatal fentanyl exposure was common in all pregnancies.”
“Although fentanyl’s effect on cholesterol metabolism has not been directly tested, based on indirect evidence, it is biologically plausible that it affects cholesterol metabolism in the developing fetus.”
They hypothesized that when a mother takes fentanyl during pregnancy, the drug disrupts the processes by which the body produces, uses and eliminates cholesterol, a fat molecule that is responsible for building membranes around cells as well as producing hormones and vitamin D is essential.
Several babies had bandaged toes and rounded “rocker feet.”
Some of the babies also had wider thumbs than usual and a single horizontal crease on their palms, as opposed to the normal two
When cholesterol cannot be processed properly by the body, it can cause damage to brain cells and tissues, as well as liver damage, growth problems, poor heart health, behavioral problems and metabolic disorders such as obesity and diabetes.
Cholesterol metabolism begins with the absorption of cholesterol through food or through synthesis in the liver. It is packaged in lipoproteins, or particles of protein and fat, designed to be transported through the blood.
There are two types of cholesterol: “good” HDL, which removes excess cholesterol from the blood and transports it back to the liver for excretion, and “bad” LDL, which transports cholesterol from the liver to cells.
When these types of cholesterol become imbalanced, hardening of the arteries can occur, increasing the risk of heart disease.
The possible connection first came to the mind of report co-author and geneticist Erin Wadman in August 2022, when she examined an infant with a similar appearance, including a smaller-than-average head and an underdeveloped jaw, to a number of previous patients, including a cleft. treated palates and unusually small bodies and heads.
The babies also tended to have upturned noses, droopy eyelids, undersized jaws and webbed toes. They may also have difficulty feeding and their thumbs may be deformed. Genetic testing ruled out a syndrome similarly called Smith-Lemli-Opitz syndrome.
Dr. Wadman told NBC News: “I was sitting there during the appointment and it just struck me that this face looked so familiar. “This story seems so familiar to me. And I was just thinking about how this patient reminded me so much of a patient that I had seen earlier in the year and other patients that I had seen.
“So we thought we might have stumbled upon something really big here.”
The mothers’ use of fentanyl was documented, but doctors did not know when and how long they took the drug during their pregnancy, necessitating further research into the condition and its causes.
Fentanyl has become a public scourge in the latest phase of the opioid epidemic, killing the equivalent of one American every eight minutes.
Opioid use during pregnancy can not only lead to small birth size, a smaller head, and sudden infant death syndrome, but also to a baby being born with neonatal abstinence syndrome.
A number of previous medical studies have found that neonatal abstinence syndrome is associated with a higher risk of death in infancy. A Seattle researcher found in 2017 that infants with a history of neonatal abstinence syndrome were 3.4 times more likely to die than infants who were not exposed to opioids in the womb.
Another 2021 study by scientists at Dartmouth College found that in their study population, 25 percent of deaths among infants exposed to opioids were due to sudden unexplained infant death syndrome, with higher rates of sudden unexplained infant death syndrome.
The researchers behind the recent study linking fentanyl to birth defects could not conclusively say that fentanyl was the cause, but acknowledged that there may have been other causes.
Fentanyl is often used as an adulterant in medications to increase the high and prolong the supply. Even with fentanyl on the street, there is repeated evidence of contamination with other highly potent compounds such as nitazene.
Researchers said: “It is not possible to rule out that an impurity in the fentanyl, rather than the fentanyl itself, is responsible for the phenotype.” Nevertheless, this clinical report is crucial in describing this novel condition and laying the foundation for future research place.”
The study was published in the journal Genetics in Medicine Open.