Sexual Abuse as a Risk Factor for Opioid Misuse in Pregnancy

Kors, Stephanie; Kurdziel-Adams, Gretchen; Towers, Craig V.; Fortner, Kimberly B.; Macfie, Jenny

doi:10.1080/10538712.2022.2056104

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…RESULTS: From September 2020 to March 2022, 18,990 individuals were screened and 5,521 were enrolled (n52,748 IOPP group, n52,773 fixed-quantity group). For the primary outcome, IOPP with shared decision making was not inferior to fixed quantity (59.5% vs 60.1%, risk difference 0.67%; 95% CI, 22.03% to 3.37%, noninferiority margin 25.0) and resulted in significantly fewer tablets received (median 14 [interquartile range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] vs 20, P,.001) through 90 days postpartum.…”

Section: Methodsmentioning

confidence: 99%

“…Individuals were excluded if they 1) had undergone a combined vaginal-cesarean birth, 2) had filled an antepartum opioid prescription, 3) had a history of opioid use disorder or a contraindication to opioids or both acetaminophen and ibuprofen, 4) had undergone significant surgical procedures (eg, hysterectomy) during their cesarean birth, 5) had a fetal or neonatal death before randomization, 6) did not speak English or Spanish, or 7) had previously participated in the trial. To estimate important gender-specific risk factors for development of opioid misuse, including psychiatric condition 8,16 and preadolescent sexual abuse, 17 we collected ORT (Opioid Risk Tool) 18 scores for eligible individuals who elected to participant in the trial. Those who elected not to participate in the trial were consented for ORT score collection only.…”

Section: Methodsmentioning

confidence: 99%

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Optimizing Opioid Prescription Quantity After Cesarean Delivery

Smid,

Clifton,

Rood

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To test whether an individualized opioid-prescription protocol (IOPP) with a shared decision-making component can be used without compromising postcesarean pain management. METHODS: In this multicenter randomized controlled noninferiority trial, we compared IOPP with shared decision making with a fixed quantity of opioid tablets at hospital discharge. We recruited at 31 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Study participants had uncomplicated cesarean births. Follow-up occurred through 12 weeks postdischarge. Individuals with complicated cesarean births or history of opioid use in the pregnancy were excluded. Participants were randomized 1:1 to IOPP with shared decision making or fixed quantity (20 tablets of 5 mg oxycodone). In the IOPP group, we calculated recommended tablet quantity based on opioid use in the 24 hours before discharge. After an educational module and shared decision making, participants selected a quantity of discharge tablets (up to 20). The primary outcome was moderate to severe pain (score 4 or higher [possible range 0–10]) on the BPI (Brief Pain Inventory) at 1 week after discharge. A total sample size of 5,500 participants was planned to assess whether IOPP with shared decision making was not inferior to the fixed quantity of 20 tablets. RESULTS: From September 2020 to March 2022, 18,990 individuals were screened and 5,521 were enrolled (n=2,748 IOPP group, n=2,773 fixed-quantity group). For the primary outcome, IOPP with shared decision making was not inferior to fixed quantity (59.5% vs 60.1%, risk difference 0.67%; 95% CI, −2.03% to 3.37%, noninferiority margin −5.0) and resulted in significantly fewer tablets received (median 14 [interquartile range 4–20] vs 20, P<.001) through 90 days postpartum. CONCLUSION: Compared with fixed quantity, IOPP with shared decision making was noninferior for outpatient postcesarean analgesia at 1 week postdischarge and resulted in fewer prescribed opioid tablets at discharge. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04296396.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Optimizing Opioid Prescription Quantity After Cesarean Delivery

Smid,

Clifton,

Rood

et al. 2024

Obstetrics &Amp; Gynecology

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“…Pregnant people with SUD experience discrimination, are denied dignity and respect, and often lack access to evidencebased care (24). Pregnant people with SUD often have a significant history of trauma, including childhood physical or sexual abuse and current intimate partner violence (25)(26)(27). Many have interacted with the child welfare system in the past and the potential of child welfare involvement postpartum looms over the entire perinatal period (28,29).…”

Section: Principles and Contextmentioning

confidence: 99%

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

Barber

Terplan

2023

Front. Pediatr.

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Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.

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“…Stigmatization, the feelings of the sexual violence victims who feel guilty, ashamed, and have a bad self-image (Kors et al, 2022). Some victims are angry at their bodies due to the abuse they experienced.…”

Section: Management Of Manpower Planning At the Center For The Protec...mentioning

confidence: 99%

The Importance of Counselor Communication Management in Trauma Recovery for Child Victims of Sexual Violence

Mukhlisiana,

Kuswarno,

Rizal

et al. 2023

SMC

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Children who are vulnerable to experiencing sexual violence have limited knowledge and experience, so it is challenging to understand acts of violence that occur to them and how to respond to them. This condition makes it increasingly difficult for them to open up and express the traumatic event. The conditions like this will complicate trauma recovery efforts by counselors. This study aims to reveal counselor communication management that examines, among other things, manpower planning management, case management, and the importance of communication management in the trauma recovery process of child victims of sexual violence. A two-year longitudinal qualitative case study was conducted to find reasons and reveal the importance of communication management for counselors in the recovery of trauma from child victims of sexual violence using data through in-depth interviews, observation, and documentation studies from 14 informants at the Center for the Protection of Women and Children. The study results show that counselor communication management is vital to ensure that the process of handling child victims of sexual violence runs properly. This communication management is expected to be a way for the counselor to carry out his duties properly where he can manage himself, manage communication with child victims of sexual violence and manage communication with related parties, both internal and external.

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Sexual Abuse as a Risk Factor for Opioid Misuse in Pregnancy

Cited by 6 publications

References 19 publications

Optimizing Opioid Prescription Quantity After Cesarean Delivery

Optimizing Opioid Prescription Quantity After Cesarean Delivery

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

The Importance of Counselor Communication Management in Trauma Recovery for Child Victims of Sexual Violence

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