Neonatal and longer term management following substance misuse in pregnancy

Mactier, Helen

doi:10.1016/j.earlhumdev.2013.08.024

Cited by 20 publications

(10 citation statements)

References 22 publications

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“…This polysubstance exposure, in addition to prescribed psychotropic medications, may exacerbate the assessment, treatment and risk of neonatal opioid withdrawal 15,16 . The risks of poor pregnancy outcomes in women who use substances likely reflect not just the substances themselves, but also the social and environmental circumstances that surround substance use 17 .…”

Section: Discussionmentioning

confidence: 99%

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

Brogly

Saia

Werler

et al. 2018

Obstetrics &Amp; Gynecology

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Objective: To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder. Methods: Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index (ASI) was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts. Results Most women in the cohort were non-Hispanic white (80.5%), with a mean age of 28 years. Few women were married (8.9%). Over half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) was infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (26.6%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychological (0.375±0.187) ASI scores were the highest, indicating the most severe problems in these areas. Opioid use–relapse did not differ by treatment (44.7% overall)Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (N=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one still birth), with an overall live-birth rate of 90.8% (95% CI: 82.7, 95.9). Conclusions: These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population.

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Section: Discussionmentioning

confidence: 99%

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

Brogly

Saia

Werler

et al. 2018

Obstetrics &Amp; Gynecology

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“…In one large national data set, the reported median length of hospital stay for NAS was 19 days (Tolia et al, 2015). Some studies have suggested that prenatal substance exposure may result in negative birth outcomes, including low birthweight and prematurity (Walton-Moss, McIntosh, Conrad, & Kiefer, 2009), delayed cognitive and motor development (Mactier, 2013), and increased child protective involvement (Lean, Pritchard, & Woodward, 2013). There exists no definitive evidence, however, that opioid exposure alone results in negative long-term developmental outcomes in children; adverse childhood experiences and toxic stress, which includes health disparities related to poverty and rurality, contribute to poor outcomes, and may be mitigated by access to treatment and care (Holbrook & Nguyen, 2015;Shonkoff & Garner, 2012).…”

Section: Impact Of Maternal Substance Use On Newbornsmentioning

confidence: 99%

Rural Postpartum Women With Substance Use Disorders

et al. 2018

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The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.

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“…Although the ABM offers the most comprehensive recommendations for breastfeeding infants with NAS, other organizations, such as AAP and ACOG, offer guidance as well. Some practitioners may recall that the AAP previously endorsed breastfeeding if a woman was taking methadone doses of 20 mg or lower; however, this is no longer a current recommendation. The AAP guidelines now state that breastfeeding infants with NAS is recommended in most situations due to its association with less severe NAS that is less likely to require pharmacologic treatment .…”

Section: Organizational Recommendationsmentioning

confidence: 99%

Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome

2017

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Breastfeeding offers many benefits to both mother and baby. Breastfeeding is generally recommended for mothers of infants with neonatal abstinence syndrome (NAS) unless some associated risk outweighs the benefits. Evidence indicates that infants with NAS who receive human milk require less pharmacologic treatment and have shorter hospital lengths of stay. Perhaps the greatest barrier to breastfeeding for women with opioid dependence is the inaccurate and inconsistent information they receive from different sources, including health care professionals. The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and Academy of Breastfeeding Medicine (ABM) have published statements that support breastfeeding infants with NAS. The ABM has a dedicated protocol to guide clinicians in deciding which mothers should and which mothers should not breastfeed their infants. In this review, studies evaluating the effects of breastfeeding, professional organizations' protocols and recommendations regarding breastfeeding, and barriers to breastfeeding infants with NAS are discussed, as well as the dangers of illicit drug exposure and avoiding rebound NAS in a breastfed infant. Clinicians can play an important role in in identifying, supporting, counseling, and advocating for mothers who wish to breastfeed their infant with NAS.

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Neonatal and longer term management following substance misuse in pregnancy

Cited by 20 publications

References 22 publications

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

Rural Postpartum Women With Substance Use Disorders

Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome

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