Association between Prenatal Tobacco Exposure and Outcome of Neonates Born to Opioid-Maintained Mothers

Abstract

Background: Prenatal nicotine exposure is associated with increased neonatal mortality, low birth weight, and smaller head circumference. Opioid-dependent pregnant women show a particularly high prevalence of tobacco smoking and are at greater risk for additional adverse events. However, little is known about the impact of tobacco smoking on opioid-maintained pregnant women and neonatal outcomes. Patients and Methods: This study examined the effect of cigarette smoking on 139 opioid-maintained pregnant women and their neonates. Forty-five percent of the participants were maintained on slow-release oral morphine (SROM), 39% received methadone maintenance, and 16% received buprenorphine. Participants were divided into two groups: (1) women who reported a low cigarette consumption of ≤10 cigarettes/day (56.8%) and (2) those reporting heavy consumption of ≥20 cigarettes/day (43.2%). Neonatal outcome measures were assessed, and a standardized Finnegan score was applied to determine the neonatal abstinence syndrome (NAS). Results: Fifty-two percent of the newborns did not require treatment for NAS (54% of neonates born to methadone-maintained mothers, 30% born to SROM-maintained mothers, and 95% born to buprenorphine-maintained mothers; p < 0.001). Heavy cigarette consumption was associated with significantly lower neonatal birth weight (p < 0.001), smaller birth length (p = 0.017) as well as with the severity of NAS (p = 0.03). With regard to concomitant consumption of opioids (p = 0.54), cocaine (p = 0.25), amphetamines (p = 0.90) or benzodiazepines (p = 0.09), no significant differences between heavy or low nicotine consumption were noted. Conclusion: Heavy tobacco smoking in opioid-maintained pregnant women is associated with adverse medical and developmental consequences for the newborn. Future treatment programs for this target group should focus on an individualized approach to opioid maintenance therapy in addition to offering specially tailored counseling for smoking cessation.

Observational Study of Buprenorphine Treatment of Opioid-Dependent Pregnant Women in a Family Medicine Residency: Reports on Maternal and Infant Outcomes

“…Previous studies have found a positive relationship between heavy tobacco use and NAS severity. 3,23 In this case series, infants born to mothers who used tobacco had a significantly lower birth weight (P ϭ .0136) than infants born to nonusers. This is consistent with the literature pertaining to tobacco use during pregnancy in the non-opioid-dependent population.…”

Prenatal Smoking Exposure and the Risk of Behavioral Problems and Substance Use in Adolescence: the TRAILS Study

“…MSP was assessed by asking the mother how many cigarettes she smoked during pregnancy (7 categories, ranging from none to more than 2 packs a day). In line with previous studies [4] , this variable was recoded into 3 categories: no smoking (0), 1-10 cigarettes a day (1), and 11 cigarettes a day or more (2). A previous study on the same dataset, comparing these self-report data with data on MSP registered shortly after birth by Preventive Child Healthcare (data were available for a subset (32%, n = 708) of the sample), indicated a high level of agreement between these reports ( = 0.77) [20] .…”

“…It is well established that maternal smoking during pregnancy (MSP) can have detrimental effects on the fetus, in particular a low birth weight and preterm birth [1,2] . In recent years a growing number of studies have focused on the effects of MSP during pregnancy on developmental and behavioral outcomes, reporting associations with a variety of symptoms and disorders in childhood and adolescence, including increased levels of attention deficit hyperactivity disorder (ADHD), exter-…”

Influence of Site Differences between Urban and Rural American and Central European Opioid-Dependent Pregnant Women and Neonatal Outcome Characteristics

“…A lack of access to treatment or problems with compliance frequently results in unplanned pregnancies or delayed identification and subsequently late start of antepartum care as well as gynecological/obstetrical complications such as premature delivery, stillbirth, or placental disruption [5,6,7]. Moreover, psychiatric comorbidities, in particular anxiety disorders and depression, are highly prevalent, frequently untreated, and further complicate treatment of this special patient population [8].…”