Caring for Opioid-dependent Pregnant Women

Abstract

Pregnancy is an opportune time to identify opioid dependence, facilitate conversion to opioid maintenance treatment, and coordinate care with specialists in addiction medicine, behavioral health and social services. Comprehensive prenatal care for opioid dependent women involves the evaluation and management of co-occurring psychiatric disorders, polysubstance use, infectious diseases, social stressors and counseling regarding the importance of breastfeeding, contraception and neonatal abstinence syndrome. While the complex psychiatric, social and environmental factors faced by this population pose significant challenges to obstetric care providers, the development of strong patient-provider relationships can facilitate the ability to deliver efficient and effective health care during pregnancy.

Drug Use during Pregnancy and its Consequences: A Nested Case Control Study on Severe Maternal Morbidity

“…3 Furthermore, there is evidence that substance abuse has several undesirable consequences on the mother and the fetus. 15,[24][25][26] Concerning the consequences of drug use on the pregnant woman and the fetus, when SMM is considered as a whole, no differences in licit or illicit drug use during pregnancy were identified in the groups with and without SMM. No other comparative study exists in the literature, since a previous evaluation of the consequences of drug use was not conducted with a composite outcome using SMM, as we have done.…”

Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder

“…[17] Similarly, women with OUD often face profound social and economic challenges in the postpartum period and our results emphasize the need to identify alternative approaches for the delivery of contraceptive services outside of the traditional postpartum visit. [5, 18]…”

“…Increased healthcare utilization and enhanced patient engagement during pregnancy and the postpartum period provide a unique opportunity to address the reproductive health needs of women with OUD including increasing access to LARC methods [5]. Despite this, contraception utilization in the postpartum period remains low.…”

Combination therapy of sofosbuvir and ribavirin fails to clear chronic hepatitis E infection in a multivisceral transplanted patient

“…Our observation is consistent with previous reports suggesting insufficient efficacy of SOF/RBV combination therapy in patients with chronic HEV infection, including a patient with stem cell transplantation 6 and immunosuppression due to chronic HIV infection. 3 A recent report of a sustained virologic response after treatment with SOF/RBV 9 has been discussed. 10 As depicted in Table 2, our patient and other case reports comprising patients with different subtypes of HEV genotype 3 treated with varying SOF/RBV treatment regimens showed comparable response patterns, exhibiting an initial decrease of viral load followed by a viral rebound either under treatment or after cessation of treatment.…”

“…However, there have been anecdotal reports about chronic HEV infection in patients receiving immunosuppressive medication regimens including rituximab or inhibitors of TNF-a. 1,7 Chronic HEV infection has also been reported in patients under immunosuppression due to human immunodeficiency virus (HIV) 3 or following stem cell transplantation. 4 Current treatment guidelines recommend the initiation of ribavirin (RBV) monotherapy for 3-6 months for patients failing to clear HEV after a reduction of immunosuppression.…”