The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy

Stewart, Robert D.; Nelson, David B.; Adhikari, Emily H.; McIntire, Donald D.; Roberts, Scott W.; Dashe, Jodi S.; Sheffield, Jeanne S.

doi:10.1016/j.ajog.2013.05.026

Cited by 67 publications

(70 citation statements)

References 10 publications

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“…19–23 Before detoxification, most participants had documented opioid use (primarily through urine drug testing), although the distinction between heroin and prescription opioids was not always clear. Other non-opioid illicit substance use was reported in six studies 20,23–27 and tobacco use was reported in five. 23,25–28 Significant heterogeneity related to the presence of a comparison group and the types of comparison groups used to evaluate differences in maternal and neonatal outcomes existed across the studies.…”

Section: Resultsmentioning

confidence: 99%

Opioid Detoxification During Pregnancy

Terplan

Laird

Hand

et al. 2018

Obstetrics &Amp; Gynecology

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OBJECTIVE To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy. DATA SOURCES PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016. METHODS OF STUDY SELECTION English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale. TABULATION, INTEGRATION, AND RESULTS Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]). CONCLUSIONS Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

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Section: Resultsmentioning

confidence: 99%

Opioid Detoxification During Pregnancy

Terplan

Laird

Hand

et al. 2018

Obstetrics &Amp; Gynecology

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“…39 Among the five retrospective case series involving women with heroin addiction, there is no consensus on the rate of methadone taper or the superiority of inpatient versus outpatient detoxification (Box 4). [40][41][42][43][44] Although the literature cites concerns for increased rates of miscarriage with detoxification during the first trimester and increased rates of preterm labour with detoxification during the third trimester, 45,46 this effect was not shown. 40,43 Neonatal outcomes, when reported, were inconsistent.…”

Section: Is There a Role For Detoxification In Pregnancy?mentioning

confidence: 85%

The management of opioid dependence during pregnancy in rural and remote settings

Jumah

Graves

2014

CMAJ

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• Nonmedical use of prescription opioids during pregnancy is becoming more common, and members of Canada's Aboriginal population are disproportionately affected.• Methadone maintenance therapy has logistic limitations in rural and remote settings, but buprenorphine and slow-release morphine maintenance therapies are feasible alternatives.• Opioid detoxification in pregnancy is associated with high rates of relapse and should only be offered if a comprehensive rehabilitation program is available.• Treatment of opioid dependence and rehabilitation services should be provided to all women during pregnancy and the postpartum period.

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“…Group and/or individual counselling with clinicians trained in drug and alcohol behavioural therapy should accompany MAT initiation and is essential for successful drug treatment 29–31. Opioid withdrawal is associated with illicit drug use relapse in pregnancy 32 33…”

Section: Maternal and Prenatal Carementioning

confidence: 99%

The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care

Pryor

Maalouf

Krans

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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As the prescription opioid epidemic grew in the USA, its impact extended to pregnant women and their infants. This review summarises how increasing rates of neonatal abstinence syndrome resulted in a need to improve care to pregnant women and opioid-exposed infants. We discuss the variations in care delivery with particular emphasis on screening at-risk mothers, scoring systems for neonatal drug withdrawal, type and duration of pharmacotherapy, and discharge safety.

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The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy

Cited by 67 publications

References 10 publications

Opioid Detoxification During Pregnancy

Opioid Detoxification During Pregnancy

The management of opioid dependence during pregnancy in rural and remote settings

The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care

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