Obstetrical and Neonatal Outcomes of Methadone-Maintained Pregnant Women: A Canadian Multisite Cohort Study

Ordean, Alice; Graves, Lisa; Abrahams, Ron; Kim, Theresa

doi:10.1016/s1701-2163(15)30311-x

Cited by 28 publications

(29 citation statements)

References 10 publications

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“…SOGC's policy paper reports that breastfeeding initiation among women on opioid maintenance therapy is as low as 20% to 75% and decreases further by 6 to12 weeks postpartum . A retrospective chart review of 94 women on methadone maintenance therapy conducted in Vancouver, Montreal, and Toronto who received care between 1997 and 2009 found a 17% initiation rate that did not vary significantly by city . The low rate of breastfeeding among women on opioid maintenance therapy raises the question of why this is the case; the best way to answer such a question is to ask the women themselves.…”

Section: Resultsmentioning

confidence: 99%

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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Introduction:Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations.Methods: CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy.Results: Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. Discussion:Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population. 545 RESULTSA total of 558 results were found, 154 duplicates were removed, and 404 titles and abstracts were screened. Of the 404 articles, 344 were excluded for failing to meet inclusion 546

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Section: Resultsmentioning

confidence: 99%

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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“…31,32 Integrated mother-infant care leads to optimal outcomes for healthy mothers and infants, including those with neonatal abstinence syndrome. 33 Rooming-in also provides more security, may avoid newborn abductions or switches, leads to decreased infant abandonment, 34 and provides more opportunity for supervised maternalnewborn interactions. 35 Hospital staff members caring for mother-infant dyads have more opportunities to empower mothers to care for their infants than when infant care is conducted without the mother and in a separate nursery.…”

Section: Evidence For Ssc and Rooming-inmentioning

confidence: 99%

Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns

Feldman-Winter¹,

Goldsmith²

2016

Pediatrics

163

110

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Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to infl uence sleeping practices after discharge. Hospitals and birthing centers have found it diffi cult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies.

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“…5 Maternal-newborn contact, rooming-in, and breastfeeding may help to decrease the severity of NAS and the need for pharmacological treatment of NAS. 5,6 In our study of one rural hospital over a 15 month period, we found that our incidence of symptomatic NAS infants was 33 per thousand. Most of these infants were not identified during a prenatal history or prenatal urine drug screen.…”

Section: Discussionmentioning

confidence: 77%

The Impact of Neonatal Abstinence Syndrome: The View from a Rural Kentucky Hospital

Crowell¹,

Crump-Rogers²,

Crump³

et al. 2017

mjm

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Obstetrical and Neonatal Outcomes of Methadone-Maintained Pregnant Women: A Canadian Multisite Cohort Study

Cited by 28 publications

References 10 publications

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns

The Impact of Neonatal Abstinence Syndrome: The View from a Rural Kentucky Hospital

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