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Pregnancy substance use disorder

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https://www.readbyqxmd.com/read/28291588/discharge-against-medical-advice-in-the-united-states-2002-2011
#1
Kiara K Spooner, Jason L Salemi, Hamisu M Salihu, Roger J Zoorob
OBJECTIVE: To describe the national frequency, prevalence, and trends of discharge against medical advice (DAMA) among inpatient hospitalizations in the United States and identify differences across patient- and hospital-level characteristics, overall and in clinically distinct diagnostic subgroups. PATIENTS AND METHODS: We conducted a retrospective, cross-sectional analysis of inpatient hospitalizations (≥18 years), discharged between January 1, 2002, and December 31, 2011, using the Nationwide Inpatient Sample...
March 10, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28278146/cdc-grand-rounds-public-health-strategies-to-prevent-neonatal-abstinence-syndrome
#2
Jean Y Ko, Sara Wolicki, Wanda D Barfield, Stephen W Patrick, Cheryl S Broussard, Kimberly A Yonkers, Rebecca Naimon, John Iskander
Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that most commonly occurs in infants after in utero exposure to opioids, although other substances have also been associated with the syndrome (1). NAS usually appears within 48-72 hours of birth with a constellation of clinical signs, including central nervous system irritability (e.g., tremors), gastrointestinal dysfunction (e.g., feeding difficulties), and temperature instability (1) (Box 1). Opioid exposure during pregnancy might result from clinician-approved use of prescription opioids for pain relief; misuse or abuse of prescription opioids; illicit use (e...
March 10, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28270105/economic-evaluation-of-a-behavioral-intervention-versus-brief-advice-for-substance-use-treatment-in-pregnant-women-results-from-a-randomized-controlled-trial
#3
Xiao Xu, Kimberly A Yonkers, Jennifer Prah Ruger
BACKGROUND: Substance use in pregnancy is associated with severe maternal and fetal morbidities and substantial economic costs. However, few studies have evaluated the cost-effectiveness of substance use treatment programs in pregnant women. The purpose of this study was to evaluate the economic impact of a behavioral intervention that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) for treatment of substance use in pregnancy, in comparison with brief advice...
March 7, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28219965/a-public-health-response-to-opioid-use-in-pregnancy
#4
Stephen W Patrick, Davida M Schiff
The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs...
February 20, 2017: Pediatrics
https://www.readbyqxmd.com/read/28188773/maternal-buprenorphine-treatment-and-fetal-neurobehavioral-development
#5
Lauren M Jansson, Martha Velez, Krystle McConnell, Nancy Spencer, Michelle Tuten, Hendree E Jones, Van L King, Neeraj Gandotra, Lorraine A Milio, Kristin Voegtline, Janet A DiPietro
BACKGROUND: Gestational opioid use/misuse is escalating in the United States; however, little is understood about the fetal effects of medications used to treat maternal opioid use disorders. OBJECTIVE: The purpose of this study was to determine the effect of maternal buprenorphine administration on longitudinal fetal neurobehavioral development. STUDY DESIGN: Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment facility with generally uncomplicated pregnancies underwent fetal monitoring for 60 minutes at times of trough and peak maternal buprenorphine levels...
February 7, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28178050/filled-prescriptions-for-opioids-after-vaginal-delivery
#6
Marian Jarlenski, Lisa M Bodnar, Joo Yeon Kim, Julie Donohue, Elizabeth E Krans, Debra L Bogen
OBJECTIVE: To estimate the prevalence of filled opioid prescriptions after vaginal delivery. METHODS: We conducted a retrospective cohort study of 164,720 Medicaid-enrolled women in Pennsylvania who delivered a liveborn neonate vaginally from 2008 to 2013, excluding women who used opioids during pregnancy or who had an opioid use disorder. We assessed overall filled prescriptions as well as filled prescriptions in the presence or absence of the following pain-inducing conditions: bilateral tubal ligation, perineal laceration, or episiotomy...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28160896/patient-centered-care-to-address-barriers-for-pregnant-women-with-opioid-dependence
#7
REVIEW
Mary Beth Sutter, Sarah Gopman, Lawrence Leeman
Pregnant women affected by substance use often encounter barriers to treatment, including housing insecurity, poverty, mental health issues, social stigma, and access to health care. Providers may lack the resources needed to provide quality care. Clinicians offering prenatal care to women with substance use disorder are encouraged to support family-centered, multidisciplinary care to women and their infants, focusing on harm reduction. Collaboration between providers of maternity care, substance abuse treatment, case management, family primary care, and pediatric developmental care can improve outcomes during pregnancy and through the early years of parenting...
March 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28129942/characterization-of-u-s-state-laws-requiring-health-care-provider-reporting-of-perinatal-substance-use
#8
Marian Jarlenski, Caroline Hogan, Debra L Bogen, Judy C Chang, Lisa M Bodnar, Elizabeth Van Nostrand
BACKGROUND: State policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients' care seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes. OBJECTIVES: This study sought to characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws...
January 24, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28107153/human-trafficking-mental-illness-and-addiction-avoiding-diagnostic-overshadowing
#9
Hanni Stoklosa, Marti MacGibbon, Joseph Stoklosa
This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health, and substance use disorder issues. The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine, and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents. In their discussion, the authors explicate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27940055/the-effects-of-sildenafil-citrate-on-uterine-angiogenic-status-and-serum-inflammatory-markers-in-an-l-name-rat-model-of-pre-eclampsia
#10
Nerolen Soobryan, Saravanakumar Murugesan, Wendy Phoswa, Prem Gathiram, Jagidesa Moodley, Irene Mackraj
Pre-eclampsia (PE), a hypertensive disorder of pregnancy, is detrimental to both mother and foetus. There is currently no effective treatment, but we have shown that Sildenafil Citrate (SC) improve various foetal outcomes in N(ω)-nitro-L arginine methyl ester (L-NAME) rat model of PE. Therefore, we aimed to investigate the effects of SC on a uterine angiogenic status and serum inflammatory markers in an L-NAME rat model of PE. One hundred and twenty adult nulliparous pregnant female Sprague-Dawley rats were used for the study...
December 7, 2016: European Journal of Pharmacology
https://www.readbyqxmd.com/read/27915237/placental-morphology-in-fetal-alcohol-spectrum-disorders
#11
Marlene Tai, Anna Piskorski, Jennifer C W Kao, Lynn A Hess, Suzanne M de la Monte, Füsun Gündoğan
AIMS: Maternal alcohol drinking adversely affects pregnancy outcome. Although fetal health and development are highly dependent upon the integrity of placentation, little is known about placental morphology following gestational exposure to alcohol in humans. METHODS: In this clinical study, subjects were recruited between 2010 and 2013 from an outpatient substance abuse and mental health treatment center for women. Data collected included maternal age, substance abuse history, comorbidities, pregnancy outcomes, gestational age at delivery, birth weight and placental weight...
December 3, 2016: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
https://www.readbyqxmd.com/read/27824771/maternal-deaths-from-suicide-and-overdose-in-colorado-2004-2012
#12
Torri D Metz, Polina Rovner, M Camille Hoffman, Amanda A Allshouse, Krista M Beckwith, Ingrid A Binswanger
OBJECTIVE: To ascertain demographic and clinical characteristics of maternal deaths from self-harm (accidental overdose or suicide) to identify opportunities for prevention. METHODS: We report a case series of pregnancy-associated deaths resulting from self-harm in the state of Colorado between 2004 and 2012. Self-harm deaths were identified from several sources, including death certificates. Birth and death certificates along with coroner, prenatal care, and delivery hospitalization records were abstracted...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27807736/-analgesic-drugs-during-pregnancy
#13
S Hultzsch, C Schaefer
Some important limitations must be taken into consideration for analgesic therapy during pregnancy. Paracetamol is the agent of choice for mild to moderate pain in any stage of pregnancy. Ibuprofen is the non-steroidal anti-inflammatory drug (NSAID) of choice; however, these substances are contraindicated after 28 weeks of gestation due to the increasing risk of premature closure of the ductus arteriosus and impairment of fetal kidney function. Even opioids can be used for severe pain but peripartum administration can lead to neonatal respiratory depression and adaptation disorders and long-term therapy up to the end of pregnancy can lead to neonatal withdrawal symptoms...
December 2016: Der Schmerz
https://www.readbyqxmd.com/read/27773527/a-moral-or-medical-problem-the-relationship-between-legal-penalties-and-treatment-practices-for-opioid-use-disorders-in-pregnant-women
#14
Cara Angelotta, Carol J Weiss, John W Angelotta, Richard A Friedman
OBJECTIVE: The relationship between use of medication-assisted treatment (MAT) in pregnant women with opioid use disorders, the standard of care, and state laws that permit child abuse charges for illicit drug use during pregnancy has not been described. METHODS: Using publicly available data on substance abuse treatment in the United States, we describe patterns in the use of MAT for pregnant women with opioid use disorders in states with prenatal child abuse laws compared with states without such laws...
October 20, 2016: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/27760409/incidence-and-recurrence-of-common-mental-disorders-after-abortion-results-from-a-prospective-cohort-study
#15
Jenneke van Ditzhuijzen, Margreet Ten Have, Ron de Graaf, Peter Lugtig, Carolus H C J van Nijnatten, Wilma A M Vollebergh
Research in the field of mental health consequences of abortion is characterized by methodological limitations. We used exact matching on carefully selected confounders in a prospective cohort study of 325 women who had an abortion of an unwanted pregnancy and compared them 1-to-1 to controls who did not have this experience. Outcome measures were incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, substance use disorders, and the aggregate measure 'any mental disorder') as measured with the Composite International Diagnostic Interview (CIDI) version 3...
January 2017: Journal of Psychiatric Research
https://www.readbyqxmd.com/read/27611068/brain-derived-neurotrophic-factor-moderates-associations-between-maternal-smoking-during-pregnancy-and-offspring-behavioral-disorders
#16
Ardesheer Talati, Zagaa Odgerel, Priya J Wickramaratne, Myrna M Weissman
Maternal smoking during pregnancy is associated with a number of adverse offspring outcomes. In the present study, based on 209 offspring from a 3-generation family study of depression, we show that the effects of prenatal exposure on offspring externalizing psychopathology (conduct, substance use disorder) is more pronounced in the presence of lower-expressing brain derived neurotrophic factor (BDNF) gene variants. BDNF plays an important role in the development and survival of neural circuits. Individuals with low-expressing variants who are further exposed to prenatal tobacco smoke may be most vulnerable to a spectrum of behavioral disorders that depend on these circuits...
November 30, 2016: Psychiatry Research
https://www.readbyqxmd.com/read/27573672/-affective-disorders-during-pregnancy-therapy-with-antidepressants-and-mood-stabilizers
#17
REVIEW
N Bergemann, W E Paulus
BACKGROUND: It is not rare that the first manifestation or relapse of an affective disorder occurs during pregnancy. Should a pharmacological treatment be indicated, the selection of a suitable substance should be made on a basis which is as safe as possible. Even when treating women of childbearing age it should be assured that the psychotropic drug selected is safe to use during pregnancy as a high percentage of pregnancies are unplanned. OBJECTIVE: When assessing the risks and benefits of psychopharmacotherapy in women who are or wish to get pregnant, not only the exposure of the child to potentially teratogenic drug effects but also potential complications during or after pregnancy and long-term neuropsychological issues need to be addressed...
September 2016: Der Nervenarzt
https://www.readbyqxmd.com/read/27563497/caring-for-pregnant-women-with-opioid-use-disorder-in-the-usa-expanding-and-improving-treatment
#18
REVIEW
Kelley A Saia, Davida Schiff, Elisha M Wachman, Pooja Mehta, Annmarie Vilkins, Michelle Sia, Jordana Price, Tirah Samura, Justin DeAngelis, Clark V Jackson, Sawyer F Emmer, Daniel Shaw, Sarah Bagley
PURPOSE OF THE REVIEW: Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population...
2016: Current Obstetrics and Gynecology Reports
https://www.readbyqxmd.com/read/27531735/intimate-partner-violence-experienced-by-hiv-infected-pregnant-women-in-south-africa-a-cross-sectional-study
#19
Molly Bernstein, Tamsin Phillips, Allison Zerbe, James A McIntyre, Kirsty Brittain, Greg Petro, Elaine J Abrams, Landon Myer
OBJECTIVES: Intimate partner violence (IPV) during pregnancy may be common in settings where HIV is prevalent but there are few data on IPV in populations of HIV-infected pregnant women in Southern Africa. We examined the prevalence and correlates of IPV among HIV-infected pregnant women. SETTING: A primary care antenatal clinic in Cape Town, South Africa. PARTICIPANTS: 623 consecutive HIV-infected pregnant women initiating lifelong antiretroviral therapy...
August 16, 2016: BMJ Open
https://www.readbyqxmd.com/read/27513154/incidence-of-neonatal-abstinence-syndrome-28-states-1999-2013
#20
Jean Y Ko, Stephen W Patrick, Van T Tong, Roshni Patel, Jennifer N Lind, Wanda D Barfield
Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000-2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999-2013...
August 12, 2016: MMWR. Morbidity and Mortality Weekly Report
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