Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy

Jones, Hendrée E.; Dengler, Erin; Garrison, Anna; O’Grady, Kevin E.; Seashore, Carl; Horton, Evette; Andringa, Kim; Jansson, Lauren M.; Thorp, John M.

doi:10.1016/j.drugalcdep.2013.11.006

Cited by 75 publications

(61 citation statements)

References 14 publications

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“…Similar to previous smaller studies, we found that dose of maintenance opioids did not modify the risk of NAS. 8,9 Furthermore, our findings provide important information that builds on previous studies of OPR use in pregnancy 3,35,36 and several publications describing tobacco and SSRI use in the context of opioid maintenance. [10][11][12] Both tobacco and SSRIs have been described in the literature as having individual withdrawal syndromes and unique toxidromes.…”

Section: Figurementioning

confidence: 74%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

263

195

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BACKGROUND AND OBJECTIVES: Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS). METHODS:We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.RESULTS: Of 112 029 pregnant women, 31 354 (28%) filled $1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P , .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P , .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P , .001), opioid type (P , .001), number of daily cigarettes smoked (P , .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.CONCLUSIONS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS. WHAT'S KNOWN ON THIS SUBJECT:Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is not well described. Further, factors associated with development of neonatal abstinence syndrome, a neonatal opioid withdrawal syndrome is inadequately understood.WHAT THIS STUDY ADDS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of neonatal abstinence syndrome.

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Section: Figurementioning

confidence: 74%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

263

195

View full text Add to dashboard Cite

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“…50 No relationship has been found between maternal opioid dose and NAS. 51 Neither methadone nor buprenorphine were approved for use in pregnancy.…”

Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…The relationship between maternal dose of buprenorphine at the time of delivery and the severity of NAS has been inconsistent, as some authors have found no relationship [6], while others have found that infants with a NAS score of zero were more likely to have been exposed to a lower dose of buprenorphine during pregnancy [7] . A small study of 10 infants born to women maintained on buprenorphine during pregnancy found that total buprenorphine meconium concentrations were correlated with NAS scores >4 [8] .…”

Section: Introductionmentioning

confidence: 95%

Maternal Buprenorphine Dose at Delivery and Its Relationship to Neonatal Outcomes

2015

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Background/Aims: To determine whether there is a dose-response relationship between maternal dose of buprenorphine at delivery and neonatal outcomes. Methods: This retrospective cohort study of 155 maternal-infant dyads exposed to buprenorphine during pregnancy examines the relationship between maternal dose of buprenorphine at delivery and gestational age, birthweight, method of delivery, Apgar scores at 1 and 5 min, duration of infant hospital stay, peak neonatal abstinence syndrome (NAS) score, duration of NAS and incidence of pharmacologic treatment of NAS. Results: Analyses failed to support any relationship between maternal dose of buprenorphine at delivery and any of the 9 clinical outcomes (all p values >0.093). Conclusions: This study failed to provide any evidence to support limiting or reducing maternal dose of buprenorphine during pregnancy in order to reduce possible adverse outcomes to the infant. Findings suggest that healthcare providers can focus medication decisions on maternal opioid cravings to reduce the risk of relapse to illicit opioid use rather than out of concern for adverse infant outcomes.

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Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy

Cited by 75 publications

References 14 publications

Prescription Opioid Epidemic and Infant Outcomes

Prescription Opioid Epidemic and Infant Outcomes

Neonatal Abstinence Syndrome

Maternal Buprenorphine Dose at Delivery and Its Relationship to Neonatal Outcomes

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