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Opioid use and pregnancy

Robert D Stewart, David B Nelson, Jodi S Dashe, George D Wendel
No abstract text is available yet for this article.
November 2016: Obstetrics and Gynecology
Ashish Premkumar, Mishka Terplan
No abstract text is available yet for this article.
November 2016: Obstetrics and Gynecology
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
Roman Gabrhelík, Blanka Nechanská, Viktor Mravčík, Svetlana Skurtveit, Ingunn Olea Lund, Marte Handal
Licit and illicit drug use in pregnant women constitutes a long lasting and serious problem worldwide. Information on long-term effects of maternal drug use on the child is limited. Nationwide registers provide a great potential to study short and long-term consequences for children exposed to licit and illicit drugs during pregnancy. We discuss this potential, with a special emphasis on exposure to methamphetamine, heroin and prescription drugs used for opioid maintenance treatment (OMT). We also discuss the advantages of register data and of merging such data from different regions...
September 2016: Central European Journal of Public Health
Akwugo A Eziefule, Solafa Elshatanoufy, Mili Thakur, Frederico G Rocha
Background Propofol is a widely known, commonly used drug. Complications can occur with the use of this drug, including propofol-related infusion syndrome (PRIS). PRIS, in the obstetric population, has not been documented; however, we report a case of a patient who developed PRIS after an emergent cesarean delivery of a preterm infant. Case Study A 35-year-old multigravida woman presented complaining of leakage of fluid and decreased fetal movement. Her pregnancy was complicated by methadone maintenance therapy due to a history of opioid abuse...
October 2016: American Journal of Perinatology Reports
John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
Flavia Franconi, Ilaria Campesi
Sex is one of several factors influencing pharmacological responses, but research on its effects on pharmacokinetics and pharmacodynamics, although emerging remarkably, remains poor and contains many methodological issues. In this review, the current state of knowledge about sex differences in pharmacokinetics and some hints to pharmacogenomics were evaluated. Moreover, considering that many pharmacological responses are monitored through biomarkers, the influence of sex on some biomarkers has been reported...
October 3, 2016: Current Medicinal Chemistry
Jaime R Bastian, Huijun Chen, Hongfei Zhang, Scott Rothenberger, Ralph Tarter, Dennis English, Raman Venkataramanan, Steve N Caritis
BACKGROUND: Buprenorphine is an FDA-approved maintenance therapy for opioid use disorders and is increasingly being used in pregnant women with opioid use disorders as an alternative to methadone. Dosing of buprenorphine in pregnant women is based on the regimen recommended for non-pregnant females and males. Limited data are available defining the pharmacokinetic (PK) properties of sublingual (SL) buprenorphine administered during pregnancy. OBJECTIVE: This study evaluated the impact of physiological changes associated with pregnancy on the PK of sublingual buprenorphine during and after pregnancy...
September 26, 2016: American Journal of Obstetrics and Gynecology
Keele E Wurst, Barbara K Zedler, Andrew R Joyce, Maciek Sasinowski, E Lenn Murrelle
BACKGROUND: Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. OBJECTIVE: The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. METHODS: Pregnant women and their corresponding births during 2005-2011 were identified in the Swedish Medical Birth Register...
2016: Substance Abuse: Research and Treatment
Panayotis K Thanos, Jianmin Zhuo, Lisa Robison, Ronald Kim, Mala Ananth, Ilon Choai, Adam Grunseich, Nicola M Grissom, Robert George, Foteini Delis, Teresa M Reyes
Birthweight is a marker for suboptimal fetal growth and development in utero. Offspring can be born large for gestational age (LGA), which is linked to maternal obesity or excessive gestational weight gain, as well as small for gestational age (SGA), arising from nutrient or calorie deficiency, placental dysfunction, or other maternal conditions (hypertension, infection). In humans, LGA and SGA babies are at an increased risk for certain neurodevelopmental disorders, including Attention Deficit/Hyperactivity Disorder, schizophrenia, and social and mood disorders...
September 22, 2016: International Journal of Developmental Neuroscience
Marta Concheiro, Elena Lendoiro, Ana de Castro, Eva Gónzalez-Colmenero, Ana Concheiro-Guisan, Patricia Peñas-Silva, Manuel Macias-Cortiña, Angelines Cruz-Landeira, Manuel López-Rivadulla
Drug exposure during pregnancy constitutes a major legal issue and a public health concern. Drug and metabolite determination in biological matrices from mother and newborn is an objective indication of prenatal drug exposure. However, limited data are available regarding the interpretation of these analytical results in terms of window of detection and degree of exposure. We collected paired maternal hair, meconium, placenta, and umbilical cord from 727 mother-newborn dyads. We analyzed these specimens by liquid chromatography-tandem mass spectrometry for the determination of cocaine, opioids, methadone, and amphetamines, and compared the analytical results from the four different matrices...
September 5, 2016: Drug Testing and Analysis
Asit Mittal
Cholestatic itch is a feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, the inherited form of cholestasis, and intrahepatic cholestasis of pregnancy. Although undervalued by physicians, cholestatic itch can be a source of great discomfort to the patient and significantly affects quality of life. Many pruritogens such as bile salts, opioids, serotonin, and histamine have been implicated in the pathogenesis of cholestatic itch, but no causative link has ever been established...
2016: Current Problems in Dermatology
(no author information available yet)
Assessing the risk: high vs. low antibiotic prescribing rates for RTIs ● RCOG guidance on nausea and vomiting in pregnancy ● Medical devices-USA vs. EU ● More on opioids for RLS ● Acupuncture for migraine prevention ● NICE guidance on oral health in care homes ● Liraglutide and cardiovascular outcomes in type 2 diabetes ● How useful is the study you are reading or writing?
September 2016: Drug and Therapeutics Bulletin
Cheryl Cirillo, Kim Francis
BACKGROUND: The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS. PURPOSE: The question guiding this brief is: "Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?" SEARCH STRATEGY: CINHAL/MEDLINE Complete and PubMed databases were searched using key words-NAS and breastfeeding-and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy...
August 25, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
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
Shunsuke Hyuga, Toshiyuki Okutomi, Rie Kato, Yuki Hosokawa
Various degrees of left ventricular outflow tract (LVOT) obstruction have been seen in patients with subvalvular aortic stenosis (SAS). Regional analgesia during labor for parturients with SAS is relatively contraindicated because it has a potential risk for hemodynamic instability due to sympathetic blockade as a result of vasodilation by local anesthetics. We thought continuous spinal analgesia (CSA) using an opioid and minimal doses of local anesthetic could provide more stable hemodynamic status. We demonstrate the management of a 28-year-old pregnant patient with SAS who received CSA for her two deliveries...
August 22, 2016: Journal of Anesthesia
Susan B Brogly, Kristen A Hahn, Sonia Hernandez Diaz, Martha Werler
Prenatal opioid agonist therapy with methadone or buprenorphine prevents maternal illicit opioid use and withdrawal and improves pregnancy outcomes compared to heroin use alone. Historically, methadone has been the first-line opioid agonist therapy for pregnant opioid dependent women; in recent years buprenorphine has become first-line treatment for some opioid dependent pregnant women. While there is some evidence of better outcomes in neonates exposed to buprenorphine vs. methadone, the effect of confounding from differences in women who use buprenorphine and methadone has not been carefully examined in most studies...
December 2015: Journal of Addiction Research & Therapy
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...
2016: MMWR. Morbidity and Mortality Weekly Report
Eun Jung Chang, Eun Ji Choi, Kyung Hoon Kim
Tapentadol is a novel oral analgesic with a dual mode of action as an agonist of the µ-opioid receptor (MOR), and as a norepinephrine reuptake inhibitor (NRI) all in a single molecule. Immediate release (IR) tapentadol shows its analgesic effect quickly, at around 30 minutes. Its MOR agonistic action produces acute nociceptive pain relief; its role as an NRI brings about chronic neuropathic pain relief. Absorption is rapid, with a mean maximal serum concentration at 1.25-1.5 h after oral intake. It is present primarily in the form of conjugated metabolites after glucuronidation, and excretes rapidly and completely via the kidneys...
July 2016: Korean Journal of Pain
Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh
BACKGROUND: Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns...
2016: SpringerPlus
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