Pregnancy and injecting drug use

Bell, James; Harvey-Dodds, Lucy

doi:10.1136/bmj.39514.554375.ae

Cited by 35 publications

(20 citation statements)

References 20 publications

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“…6 Recent studies in women with uncomplicated pregnancies have demonstrated the safety of gradual detoxification with methadone or clonidine in highly monitored inpatient settings. 26, 27 Although no standard protocols exist for opioid detoxification during pregnancy, the Center for Substance Abuse Treatment (CSAT), of the Substance Abuse and Mental Health Services Administration (SAMHSA), recommends methadone tapers of 1.0 to 2.5 mg per day for inpatients and by 2.5 to 10.0 mg per week for outpatients.…”

Section: Management Of Detoxificationmentioning

confidence: 99%

“…Despite these obstacles, pregnant women can be highly motivated to reduce substance use and most women strive for healthier pregnancy, providing a unique window of opportunity for intervention in this population. 6 Prior studies suggest that pregnant women struggling with addiction not only attempt to reduce their substance use, they also seek improved nutrition, sleep, and other life-style changes. 7 …”

Section: Introductionmentioning

confidence: 99%

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Evaluation and Management of Opioid Dependence in Pregnancy

2012

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Background Opioid use disorders are a growing public health problem in the United States. Most women who are opioid dependent are of childbearing age and management of opioid dependence during pregnancy poses unique challenges. Assessment includes evaluation for addiction, withdrawal syndromes, and co-morbid psychiatric diagnoses. Consultation-liaison psychiatrists may also be involved in acute pain management, perinatal medication management, buprenorphine induction and stabilization. For the past four decades, the standard of care has included methadone maintenance, but the increasing use of buprenorphine creates new treatment issues and opportunities. Objective To educate consultation-liaison psychiatrists in emergency and obstetrical settings about the appropriate approach toward the evaluation and basic management of women with opioid dependence in pregnancy. Method The authors reviewed the consensus literature and all new treatment options on opioid dependence during pregnancy. Discussion In this review, the authors summarize known and emerging management strategies for opioid dependence in pregnancy pertinent to consultation-liaison psychiatrists.

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Section: Management Of Detoxificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation and Management of Opioid Dependence in Pregnancy

2012

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“…A recent review article suggests that maternal methadone use is not associated with adverse postnatal development 21. However, there are numerous data linking maternal opiate misuse with developmental delay at ages ranging from 6 months to 12 years 22 23 24 25 26 27 28 29 30 31 32.…”

Section: Neurodevelopmental Outcomementioning

confidence: 99%

Drug misuse in pregnancy: losing sight of the baby?

McGlone

Mactier

Weaver

2009

Archives of Disease in Childhood

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Maternal drug misuse can seriously affect the health of the fetus and newborn infant. The association of maternal drug misuse with prematurity, intrauterine growth restriction (IUGR) and neonatal abstinence syndrome (NAS) is well recognised, and there is growing concern about infant visual development and longer-term neurodevelopmental outcome. Drug misuse is associated with changes in the visual system as measured by the visual evoked potential (VEP) in adults and animal models. A recent study has shown abnormal VEPs in newborn infants exposed to methadone in utero, consistent with reports of delayed visual development in this population. Since visual abnormalities and neurodevelopmental abnormalities can be predicted by abnormal VEPs in infancy, it is postulated that the VEP may be a valuable tool in the detection of the adverse effects of maternal drug misuse upon the infant. This review summarises the impact of maternal drug misuse upon the health of the fetus and newborn infant, addresses the specific effects of maternal drug misuse upon the developing visual system and discusses the potential role of the VEP in the assessment of these infants.

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“…In theory, maintenance improves psychosocial circumstances for mothers and increases medical compliance among pregnant patients [1]; but, in fact, many at-risk women abuse medical opioids during pregnancy [2]. Substitution therapy frequently leads to the newborn suffering through neonatal abstinence syndrome [3]. In developing rats, myelination is altered by perinatal exposure to therapeutic doses of methadone [4].…”

Section: Introductionmentioning

confidence: 99%

Effects of Methadone Exposure during Development on Avian Brain and Blood Cells

Gagnon¹,

Dingman²,

D’Arco³

et al. 2015

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Maintenance with methadone is standard treatment for opioid-addicted patients, including pregnant women. Cellular effects of methadone exposure during development are investigated by using an avian model, which is free of confounding maternal variables. In the first study, which explored dose by duration interactions, methadone was administered at one of two doses (0.458 mg/kg or 1.75 mg/kg) for one of three durations of exposure: late in development (Incubation Days 12 to 19), middle to late (Days 9 to 19), or early to late (Days 5 to 19). In the second study, 1.00 mg/kg of methadone was administered from days 8 to 18 and compared with controls (0.00 mg/kg). Brain tissue and blood samples were harvested for all dose conditions from the two studies. Increased methadone exposure was associated with subependymal anomalies, subependymal hemorrhaging, edema, monocytic infiltration, an increase in disintegrating red blood cells, an increase in white blood cells, and a decrease in neurons. Significant differences in variance for cell counts by condition were observed. Exposed specimens had significantly more thrombocytes (t = −2.66, p < 0.05). The anomalies suggest that methadone exposure may be harmful to develop organisms at the cellular level.

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Pregnancy and injecting drug use

Abstract: Injecting drug use has adverse effects on pregnancy and perinatal outcomes. Methadone treatment improves birth rate but carries a risk of neonatal abstinence syndrome; withdrawal of methadone during pregnancy is not recommended

Cited by 35 publications

References 20 publications

Evaluation and Management of Opioid Dependence in Pregnancy

Evaluation and Management of Opioid Dependence in Pregnancy

Drug misuse in pregnancy: losing sight of the baby?

Effects of Methadone Exposure during Development on Avian Brain and Blood Cells

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