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opioids and pregnancy

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https://www.readbyqxmd.com/read/29913015/comparison-of-safety-and-efficacy-of-methadone-vs-morphine-for-treatment-of-neonatal-abstinence-syndrome-a-randomized-clinical-trial
#1
Jonathan M Davis, Jeffrey Shenberger, Norma Terrin, Janis L Breeze, Mark Hudak, Elisha M Wachman, Peter Marro, Erica L Oliveira, Karen Harvey-Wilkes, Adam Czynski, Barbara Engelhardt, Karen D'Apolito, Debra Bogen, Barry Lester
Importance: Although opioids are used to treat neonatal abstinence syndrome (NAS), the best pharmacologic treatment has not been established. Objective: To compare the safety and efficacy of methadone and morphine in NAS. Design, Setting, and Participants: In this randomized, double-blind, intention-to-treat trial, term infants from 8 US newborn units whose mothers received buprenorphine, methadone, or opioids for pain control during pregnancy were eligible...
June 18, 2018: JAMA Pediatrics
https://www.readbyqxmd.com/read/29884421/the-pregnancy-recovery-center-a-women-centered-treatment-program-for-pregnant-and-postpartum-women-with-opioid-use-disorder
#2
Elizabeth E Krans, Stephanie Bobby, Michael England, Robert H Gedekoh, Judy C Chang, Bawn Maguire, Patty Genday, Dennis H English
OBJECTIVE: To evaluate the impact of women-centered substance abuse treatment programming on outcomes among pregnant women with opioid use disorder (OUD). METHODS: We compared two retrospective cohorts of pregnant women with OUD on buprenorphine maintenance therapy who delivered an infant at the University of Pittsburgh from 2014 to 2016. Cohort 1 was composed of pregnant women who received women-centered OUD treatment services through the Pregnancy Recovery Program (PRC) and Cohort 2 was composed of pregnant women who received buprenorphine at OUD programs without women-centered services (non-PRC)...
May 24, 2018: Addictive Behaviors
https://www.readbyqxmd.com/read/29882032/cigarette-smoking-status-and-substance-use-in-pregnancy
#3
Emmanuel A Oga, Katrina Mark, Victoria H Coleman-Cowger
Objectives Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. Methods In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine...
June 7, 2018: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/29879404/sex-differences-in-effects-of-gestational-polychlorinated-biphenyl-exposure-on-hypothalamic-neuroimmune-and-neuromodulator-systems-in-neonatal-rats
#4
Margaret R Bell, Ariel Dryden, Ryan Will, Andrea C Gore
Polychlorinated biphenyls (PCBs) are ubiquitous in the environment and exposure to them is associated with immune, endocrine and neural dysfunction. Effects of PCBs on inflammation and immunity are best described in spleen and blood, with fewer studies on neural tissues. This is an important gap in knowledge, as molecules typically associated with neuroinflammation also serve neuromodulatory roles and interact with hormones in normal brain development. The current study used Sprague-Dawley rats to assess whether gestational PCB exposure altered hypothalamic gene expression and serum cytokine concentration in neonatal animals given an immune challenge...
June 4, 2018: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29873094/gestational-changes-in-buprenorphine-exposure-a-physiologically-based-pharmacokinetic-analysis
#5
Hongfei Zhang, Hari V Kalluri, Jaime R Bastian, Huijun Chen, Ali Alshabi, Steve N Caritis, Raman Venkataramanan
INTRODUCTION: Buprenorphine (BUP) is approved by the FDA for the treatment of opioid addiction. The current dosing regimen of BUP in pregnant women is based on recommendations designed for non-pregnant adults. However, physiological changes during pregnancy may alter BUP exposure and efficacy. The objectives of this study were to develop a physiologically-based-pharmacokinetic (PBPK) model for BUP in pregnant women, to predict changes in BUP exposure at different stages of pregnancy, and to demonstrate the utility of PBPK modelling in optimising BUP pharmacotherapy during pregnancy...
June 5, 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29870574/parenteral-opioids-for-maternal-pain-management-in-labour
#6
REVIEW
Lesley A Smith, Ethel Burns, Anna Cuthbert
BACKGROUND: Parenteral opioids (intramuscular and intravenous drugs including patient-controlled analgesia) are used for pain relief in labour in many countries throughout the world. This review is an update of a review first published in 2010. OBJECTIVES: To assess the effectiveness, safety and acceptability to women of different types, doses and modes of administration of parenteral opioid analgesia in labour. A second objective is to assess the effects of opioids in labour on the baby in terms of safety, condition at birth and early feeding...
June 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29863532/gastroschisis-and-cumulative-stressor-exposures
#7
Martha M Werler, Esther Guéry, Dorothy K Waller, Samantha E Parker
BACKGROUND: Gastroschisis, a congenital defect of the abdominal wall, occurs disproportionately more in offspring of young mothers and has been increasing in prevalence over the past decades. A wide range of exposures have been reported in association with an increased gastroschisis risk, independent of mother's age; many have also been correlated with stress responses. METHODS: We explored cumulative exposures to such stressor exposures among 1,261 mothers of gastroschisis cases and 10,682 mothers of controls in the National Birth Defects Prevention Study (1997-2011)...
May 31, 2018: Epidemiology
https://www.readbyqxmd.com/read/29781504/epidural-versus-non-epidural-or-no-analgesia-for-pain-management-in-labour
#8
REVIEW
Millicent Anim-Somuah, Rebecca Md Smyth, Allan M Cyna, Anna Cuthbert
BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour...
May 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29769809/managing-infants-born-to-mothers-who-have-used-opioids-during-pregnancy
#9
Thierry Lacaze-Masmonteil, Pat O'Flaherty
The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency...
May 2018: Paediatrics & Child Health
https://www.readbyqxmd.com/read/29760859/substance-use-in-pregnant-women-using-the-emergency-department-undertested-and-overlooked
#10
C Leigh Moyer, Sean Johnson, Marilyn G Klug, Larry Burd
Introduction: The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women. Methods: We captured all ED visits over a six-year period (2010-2016) from a single community hospital and identified women of childbearing age, defined for our study as 11-50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29747726/opioid-use-disorders-and-pregnancy
#11
REVIEW
Amanda J Johnson, Cresta W Jones
Opioid use disorder presents an increased risk of complications in pregnancy, particularly when untreated. To optimize outcomes, medication-assisted treatment using methadone or buprenorphine as a part of a comprehensive care model is recommended. Neonatal abstinence syndrome and poor fetal growth remain significant complications of this disorder despite maternal treatment.
June 2018: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29744859/prescription-opioid-use-in-pregnancy
#12
REVIEW
Julie Blandthorn, Laura Leung, Yuan Loke, D Martyn Lloyd-Jones, Robin Thurman, Ellen Bowman, Yvonne Bonomo
Prescription medications, including opioid analgesics, are increasingly prescribed in Australia and internationally. More women are presenting in pregnancy with prescription opioid use which can potentially cause harm to the mother and fetus. This article outlines the different types of prescription opioids, defines how prescription opioid use disorder presents clinically and suggests a rational clinical approach to assess and manage patients in the context of pregnancy and their infants.
May 10, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29720535/hepatitis-c-virus-screening-among-children-exposed-during-pregnancy
#13
Catherine A Chappell, Sharon L Hillier, David Crowe, Leslie A Meyn, Debra L Bogen, Elizabeth E Krans
OBJECTIVES: Because of the opioid epidemic, hepatitis C virus (HCV) infection is increasing among pregnant women, resulting in an increased risk of perinatal transmission and HCV infection among children. Our primary objectives in this study were to determine the prevalence of HCV among pregnant women and the frequency of pediatric HCV screening. METHODS: A population-based, retrospective cohort of pregnant women who delivered between 2006 and 2014 was identified and classified as HCV infected or HCV uninfected by billing codes...
June 2018: Pediatrics
https://www.readbyqxmd.com/read/29704852/prevalence-of-alcohol-use-in-pregnant-women-with-substance-use-disorder
#14
Ludmila N Bakhireva, Shikhar Shrestha, Laura Garrison, Lawrence Leeman, William F Rayburn, Julia M Stephen
BACKGROUND: Prenatal care programs for women with opioid use disorder (OUD) often focus treatment/counseling plans around illicit substances, while concurrent use of alcohol might present an equal or greater risk to the fetus. METHODS: This study evaluated self-reported prevalence of alcohol use in patients participating in a comprehensive prenatal care program for women with substance use disorder (SUD; n = 295), of which 95% are treated for OUD, and pregnant women being served through general obstetrical clinics at the University of New Mexico (n = 365)...
June 1, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29692634/chronic-pain-during-pregnancy-a-review-of-the-literature
#15
REVIEW
Shona L Ray-Griffith, Michael P Wendel, Zachary N Stowe, Everett F Magann
Background and purpose: The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. Methods: A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science...
2018: International Journal of Women's Health
https://www.readbyqxmd.com/read/29651928/rural-postpartum-women-with-substance-use-disorders
#16
Debra Kramlich, Rebecca Kronk, Lenora Marcellus, Alison Colbert, Karen Jakub
The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers)...
April 1, 2018: Qualitative Health Research
https://www.readbyqxmd.com/read/29643617/comparison-of-ropivacaine-0-2-with-or-without-clonidine-1-%C3%AE-g-kg-for-epidural-labor-analgesia-a-randomized-controlled-study
#17
Indira Kumari, Kapil Sharma, Vikram Bedi, Madhan Mohan, Hemraj Tungaria, Manish Kumar Modi
Background and Aims: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. Material and Methods: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29630018/prescription-and-other-medication-use-in-pregnancy
#18
David M Haas, Derek J Marsh, Danny T Dang, Corette B Parker, Deborah A Wing, Hyagriv N Simhan, William A Grobman, Brian M Mercer, Robert M Silver, Matthew K Hoffman, Samuel Parry, Jay D Iams, Steve N Caritis, Ronald J Wapner, M Sean Esplin, Michal A Elovitz, Alan M Peaceman, Judith Chung, George R Saade, Uma M Reddy
OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29630016/opioid-detoxification-during-pregnancy-a-systematic-review
#19
Mishka Terplan, Hollis J Laird, Dennis J Hand, Tricia E Wright, Ashish Premkumar, Caitlin E Martin, Marjorie C Meyer, Hendrée E Jones, Elizabeth E Krans
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...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29610676/pregnant-or-recently-pregnant-opioid-users-contraception-decisions-perceptions-and-preferences
#20
Rebecca L Fischbein, Bethany G Lanese, Lynn Falletta, Kelsey Hamilton, Jennifer A King, Deric R Kenne
Background: Multiple factors are linked to extremely high unintended pregnancy rates among women who use opioids, including various barriers to contraception adherence. These include patient level barriers such as lack of knowledge and education about highly effective contraception, and potential provider barriers. Using a mixed-methods framework to examine the contraception-related perceptions and preferences of opioid using women is a necessary next step to understanding this phenomenon...
2018: Contraception and reproductive medicine
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