Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates

Winklbaur, Bernadette; Kopf, Nina; Ebner, Nina; Jung, Erika; Thau, K.; Fischer, Gabriele

doi:10.1111/j.1360-0443.2008.02283.x

Cited by 140 publications

(128 citation statements)

References 118 publications

(154 reference statements)

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“…Relapse rates are high and repeated cycles of intoxication and withdrawal are associated with significant fetal distress that can lead to placental insufficiency and consequent pregnancy loss, intrauterine growth restriction (IUGR) and preterm labor and birth 5, 7, 8, 9. The accepted treatment for OUD during pregnancy is long‐acting opioid agonist medication‐assisted treatment (OMAT), such as methadone (MET) or buprenorphine (BUP), within the context of a comprehensive program of obstetric care and psychosocial interventions 5, 8, 10, 11, 12, 13, 14. Adequate medication treatment maintains stable opioid blood levels that reduce maternal craving for and use of heroin or other opioids and improves prenatal care and fetal/infant outcomes compared with untreated opioid use or opioid withdrawal 11, 15, 16.…”

Section: Introductionmentioning

confidence: 99%

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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AimsTo assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.MethodsWe searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies.ResultsThree RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.ConclusionsModerately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

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Section: Introductionmentioning

confidence: 99%

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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“…Currently, opioid use in pregnancy is a growing health problem. 43,44 Women who use heroin intravenously face additional complications that include overdosing, contracting sexually transmitted and other infectious diseases, and living in potentially lethal, explosive, and 4 Not only are these pregnant women at risk physically but also they are at risk mentally due to stress and anxiety. An additional risk for pregnant women who use opioids is the concomitant use of other drugs (polysubstance use), such as alcohol, benzodiazepines, amphetamines, and cocaine, which are potentially teratogenic.…”

Section: Substance Use and Pregnancymentioning

confidence: 99%

“…An additional risk for pregnant women who use opioids is the concomitant use of other drugs (polysubstance use), such as alcohol, benzodiazepines, amphetamines, and cocaine, which are potentially teratogenic. 4,45 Pregnant women, with comorbid substance use disorders, also require a different intervention perspective. Hamilton and Campbell suggest an integrated model, which addresses the stigma of self-reported drug use, the specific drug, and the personality of the individual.…”

Section: Substance Use and Pregnancymentioning

confidence: 99%

A review of research and nursing management of mental health problems in pregnancy and motherhood

Jarosinski¹,

Fox²

2016

NRR

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Abstract:In this article, the authors explore the risks pregnant women experience due to mental illness and intimate partner violence (IPV) and discuss the nursing role involved in the management of their care. For many women, pregnancy is a time of hopeful anticipation, yet for others, pregnancy reflects a new or an ongoing struggle with mental illness. The sequelae of untreated mental illness can be as severe as infanticide, maternal suicide, lack of maternal attachment, and inability to parent. Newborns whose mothers misuse alcohol and drugs are at risk of fetal alcohol spectrum disorders and neonatal addiction syndrome. Women who live with IPV risk their physical and mental well-being as well as the safety of their newborn. Implications for practice include the use of assessment tools early and during the treatment trajectory; otherwise, mental illness and IPV in pregnancy would go undetected/untreated. Identifying postpartum depression early is key toward providing timely care for both the mother and infant; yet, few obstetric practices use a depression assessment tool such as the Edinburgh Postnatal Depression Scale. During the initial intake assessment, the Edinburgh Postnatal Depression Scale can provide the means of early treatment through targeted assessment. Further implications include specialized services for substance-misusing pregnant women whose issues are different and separate from those of men, integration of services to address their multifaceted needs, and educating nurses to the reality of comorbidity as the norm rather than the rare occurrence, with a truly holistic approach that diminishes stigma.

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“…Winklbaur et al [17] Addiction, 2008 Use of opioid medication for detox or maintenance should follow established national guidelines, but should be done in a co-ordinated and supportive environment.…”

Section: Literature Reviewsmentioning

confidence: 99%

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Gilfillan¹,

Dannatt

Stein

et al. 2018

S Afr Med J

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Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector. Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010. Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files. Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery. Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study.

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Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates

Abstract: Methodological flaws and inconsistencies confound interpretation of today's literature. Based on this synthesis of available evidence and our clinical experience, we propose recommendations for further discussion.

Cited by 140 publications

References 118 publications

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

A review of research and nursing management of mental health problems in pregnancy and motherhood

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

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