Breastfeeding Motivators and Barriers in Women Receiving Medications for Opioid Use Disorder

Yonke, Nicole; Jimenez, Elizabeth Yakes; Leeman, Lawrence; Leyva, Yuridia; Ortega, Alyssa; Bakhireva, Ludmila N.

doi:10.1089/bfm.2019.0122

Cited by 16 publications

(14 citation statements)

References 28 publications

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“…The relative impact of skin‐to‐skin contact, quality and volume of consumed breastmilk, and potential opioid drug transfer to breastmilk on the observed outcomes could not be distinguished. Although the authors acknowledged the significant obstacles to breastfeeding in this population, including psychosocial, behavioural, concomitant medications and tobacco use, other research suggests that the primary motivators and barriers for breastfeeding are similar between women using opioids and opioid use disorder compared with the general population 70 …”

Section: Resultsmentioning

confidence: 94%

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

Corsi

Murphy

2021

Basic Clin Pharma Tox

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Opioids cover a broad class of natural, synthetic and semi‐synthetic drugs that act on opioid receptors to produce powerful analgesic effects. Rates of opioid use and opioid agonist maintenance treatment have increased substantially in recent years, particularly among women. Trends and outcomes of opioids use on fertility, pregnancy and breastfeeding, and longer‐term child developmental outcomes have not been well‐described. Here, we review the existing literature on the health effects of opioid use on female fertility, pregnancy, breastmilk and the exposed infant. We find that the current literature is primarily concentrated on the impact of opioid use in pregnancy and neonatal outcomes, with little exploration of effects on fertility. Studies are limited in number, some with small sample sizes, and many are hampered by methodological challenges related to confounding and other potential biases. Opioid use is becoming more prevalent due to environmental pressures such as COVID‐19. More research is needed to better elucidate its effects on reproductive health among younger women and support the development of evidence‐based recommendations for safe prescription practices and public health messaging.

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Section: Resultsmentioning

confidence: 94%

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

Corsi

Murphy

2021

Basic Clin Pharma Tox

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“…18 The CARE patient LARC use rate and postpartum visit rate were higher than in previously published studies (35 vs. 18% and 86 vs. 30%, respectively). 11,12 The CARE patient and matched controls' postpartum visit rate compliances (86 vs. 81%) were both much higher than the national average of 60%. These findings highlight that a multidisciplinary, wrap-around, prenatal OUD clinic may be an effective solution improving these outcomes, especially in the postpartum period when relapse and overdose rates increase, mental illness worsens, and the barriers of fragmented care are critically exacerbated.…”

Section: Discussionmentioning

confidence: 93%

The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care

et al. 2022

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Objective To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. Study Design This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic—Clinic for Acceptance Recovery and Empowerment (CARE)—between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. Results A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05–1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76–1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36–1.84). Conclusion In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. Key Points

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“…Lactating patients using medication to treat opioid use disorder, such as methadone and buprenorphine, are recommended by the Academy of Breastfeeding Medicine, American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists to continue breastfeeding. 30 Hydromorphone and morphine are excreted into the breast milk in low levels. Intranasal hydromorphone distributes rapidly from plasma into breast milk; however, it does not accumulate into fat.…”

Section: Drug Considerations Analgesicsmentioning

confidence: 99%

Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More

Elder

Pianosi

Lawlor

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceThe benefits of breastfeeding are well established, with the American Academy of Pediatrics and Canadian guidelines recommending exclusive breastfeeding for the first 6 months of life. However, maternal hospitalization, illness, medication use, and poor support can result in early termination of breastfeeding. Caring for breastfeeding patients in otolaryngology is a challenge because of the lack of literature regarding otolaryngology-specific medication safety, patient concerns, and inadequate education among otolaryngologists. This review highlights recent literature regarding lactation in otolaryngology patients, including medication, radiologic imaging, perioperative considerations, and subspecialty-specific considerations for lactating patients.ObservationsThe majority of common medications used in general otolaryngology are safe for breastfeeding patients, including antihistamines, mucolytics, antitussives, antifungals, and decongestants. Certain analgesics and anti-inflammatories, such as tramadol, are not preferred in breastfeeding individuals. Some subspeciality-specific medications such as biologics (dupilumab) and methotrexate should be avoided. Lactating patients require special perioperative attention to ensure that optimal patient care is provided, such as managing supply, considering length of surgery, managing postoperative pain, and determining the safe amount of time until an infant can be fed.Conclusions and RelevanceMost medications can be safely used with lactating patients. If physicians are unsure about a medication’s safety, they should consult appropriate resources prior to recommending breastfeeding cessation or to discard pumped milk.

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Breastfeeding Motivators and Barriers in Women Receiving Medications for Opioid Use Disorder

Cited by 16 publications

References 28 publications

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care

Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More

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