Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication

Kaltenbach, Karol; Holbrook, Amber M.; Coyle, Mara G.; Heil, Sarah H.; Salisbury, Amy L.; Stine, Susan M.; Martin, Peter; Jones, Hendrée E.

doi:10.1111/j.1360-0443.2012.04038.x

Cited by 96 publications

(78 citation statements)

References 35 publications

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“…Some reports suggest that the use of tobacco and coprescription of selective serotonin reuptake inhibitors (SSRIs) may also increase the likelihood of developing NAS. [10][11][12] Using a large retrospective cohort of pregnant women, our objectives were to identify neonatal complications associated with antenatal OPR exposures and to determine if antenatal cumulative prescription opioid exposure, opioid type, number of cigarettes smoked daily, and SSRI use were associated with a higher likelihood of developing NAS.…”

Section: What This Study Addsmentioning

confidence: 99%

“…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. 5 Nevertheless, these exposures could also be associated with a constellation of other risk factors that may be difficult to measure directly (eg, substance abuse) and account for in our analyses.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

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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: What This Study Addsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

Self Cite

263

195

View full text Add to dashboard Cite

show abstract

“…In a secondary analysis of the MOTHER study, Kaltenbach and colleagues found that greater nicotine use at delivery (defined by number of cigarettes smoked in the twenty-four hours prior to birth) was associated with higher rates of treatment for NAS as well as the total dose of medication required. 61 However, maternal nicotine use did not correlate with higher peak NAS scores or duration of treatment. The same study also examined the relationship between SSRIs and the development of NAS.…”

Section: Predictive Factorsmentioning

confidence: 86%

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

Kraft

Stover

Davis

2016

Seminars in Perinatology

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Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for “personalized genomic medicine” and novel, individualized therapeutic interventions.

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“…NAS requiring pharmacotherapy occurs in 22–67% (Kocherlakota, 2014) among buprenorphine-exposed infants. Substances that may potentiate NAS severity in methadone-exposed infants include polysubstance exposures (Jansson et al, 2012), heavy cigarette smoking (Choo et al, 2004) and psychiatric medication, particularly SRIs (Kaltenbach et al, 2012). It is unknown whether these substances similarly predispose the infant to more severe NAS in buprenorphine-exposed pregnancies, or if other aspects of exposure, such as maternal buprenorphine dose, potentiates NAS in exposed infants.…”

Section: Introductionmentioning

confidence: 99%

Maternal buprenorphine treatment and infant outcome

Jansson

Vélez

McConnell

et al. 2017

Drug and Alcohol Dependence

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Background and Objectives Maternal buprenorphine maintenance predisposes the infant to exhibit neonatal abstinence syndrome (NAS), but there is insufficient published information regarding the nature of NAS and factors that contribute to its severity in buprenorphine-exposed infants. Methods The present study evaluated forty-one infants of buprenorphine-maintained women in comprehensive substance use disorder treatment who participated in an open-label study examining the effects of maternal buprenorphine maintenance on infant outcomes. Modifiers of the infant outcomes, including maternal treatment and substance use disorder parameters, were also evaluated. Results Fifty-nine percent of offspring exhibited NAS that required pharmacologic management. Both maternal buprenorphine dose as well as prenatal polysubstance exposure to illicit substance use/licit substance misuse were independently associated with NAS expression. Polysubstance exposure was associated with more severe NAS expression after controlling for the effects of buprenorphine dose. Other exposures, including cigarette smoking and SRI use, were not related to outcomes. Maternal buprenorphine dose was positively associated with lower birth weight and length. Conclusions Polysubstance exposure was the most potent predictor of NAS severity in this sample of buprenorphine-exposed neonates. This finding suggests the need for interventions that reduce maternal polysubstance use during medication assisted treatment for opioid use disorder, and highlights the necessity of a comprehensive approach, beyond buprenorphine treatment alone, for the optimal care for pregnant women with opioid use disorders.

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Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication

Cited by 96 publications

References 35 publications

Prescription Opioid Epidemic and Infant Outcomes

Prescription Opioid Epidemic and Infant Outcomes

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

Maternal buprenorphine treatment and infant outcome

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