Cigarette Smoking Reduction in Pregnant Women With Opioid Use Disorder

Abstract

Objectives Nearly 95% of women with opioid use disorder continue to smoke cigarettes during pregnancy. Despite this prevalence and the well-documented adverse effects of smoking on birth outcomes, cigarette smoking is under-addressed in this population. This study examines factors associated with successful smoking reduction among pregnant women with opioid use disorder and the impact of smoking reduction on maternal and birth outcomes. Methods This study is a secondary data analysis of maternal smoking reduction and infant birth outcomes among pregnant women with opioid use disorder (N=118) enrolled in a randomized controlled trial of a contingency management intervention in which escalating monetary vouchers were provided to women who met escalating smoking reduction targets. Results Participants’ ability to meet higher smoking reduction targets was associated with less cocaine use at baseline (p=0.022), higher carbon monoxide levels at baseline (p=0.039), fewer prior quit attempts (p=0.016), participation in the contingency management intervention, and greater adherence with the parent trial protocol. Some clinically relevant associations were found between smoking reduction and birth outcomes, including birth weight, spontaneous abortions, and neonatal abstinence syndrome treatment, but these differences did not reach statistical significance. Conclusions Contingency management promotes smoking reduction, but other factors may be associated with such reduction, including baseline smoking and illicit drug use, prior quit attempts, and willingness to participate in the incentives program. Clinicians caring for pregnant women with opioid use disorder may see greater smoking behavior change if they first encourage smoking reduction before recommending smoking cessation. Future research is needed to determine the level of smoking reduction needed to positively impact birth outcomes.

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

“…In addition, we relied on documentation in the medical record of alcohol and tobacco use during pregnancy, which in turn relied on maternal report; both exposures are likely under-reported and inconsistently documented in the medical record. Published literature reports that more than 90% of women with opioid use disorder smoke cigarettes during pregnancy, a significantly higher prevalence than the 40% in our cohort, confirming likely under-reporting and/or inconsistent documentation of this variable ( 51 – 53 ). We were also unable to evaluate the potential influence of genetic and epigenetic factors on development ( 54 ).…”

Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review

“…Although brief intervention and skill training decreased smoking levels [ 72 ], only the study by Tuten et al (2012) focused on smoking reduction among women who are pregnant in treatment with methadone for OUD and the use of financial incentives demonstrated a significant impact [ 72 ]. Active engagement in treatment to reduce smoking, as measured by numbers of collected urinalysis samples and mean days of treatment attendance, appeared to lead to a more successful smoking reduction, but even a 50% reduction in smoking was difficult to attain [ 38 ]. Recent publications indicate new studies are being planned to study interventions to REDUCE tobacco consumption in PPWOUD [ 74 , 75 ].…”

“…Note that the majority of the women in the study were smokers (n = 177 smokers vs. 18 nonsmokers) [37]. Ram et al (2016) reported that women who successfully reduced their cigarette consumption during pregnancy exhibited a nonsignificant decrease in spontaneous abortions, higher infant birth weights, and a nonsignificant reduction in the number of infants being treated for NAS (p-values > 0.05 for all comparisons) [38]. The other papers [39][40][41][42][43][44] reported no neonatal outcomes that were significantly different in infants of mothers being treated with methadone who smoked vs. those who did not smoke (p-values > 0.05).…”

Cigarette Smoking Status and Substance Use in Pregnancy

“…Secondary findings of this study are also noteworthy. More than one in ten current smokers also concurrently used opioids in pregnancy, which may not be unusual in a treatment setting given the high prevalence rates of smoking that have been reported among treatment-seeking individuals with opioid use disorder (Chun et al 2009; Ram et al 2016), but was not anticipated in a prenatal care clinic setting. Additionally prevalence rates of cannabis and opioids use in our sample of pregnant women are higher when compared to recent studies on cannabis and opioid use in pregnancy for other populations (Brown et al 2017; Osmundson et al 2018).…”