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Opioid use and pregnancy

Joe Dooley, Gareth Ryan, Lianne Gerber Finn, Megan Bollinger, Cai-Lei Matsumoto, Wilma M Hopman, Len Kelly
INTRODUCTION: Opioid use in pregnancy is increasing globally. In northwest Ontario, rates of neonatal abstinence syndrome (NAS) are alarmingly high. We sought to document the increasing rates of opioid exposure during pregnancy and associated cases of NAS over a 7-year period in northwest Ontario. METHODS: We conducted a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre catchment area (population 29 000) maternity program in northwest Ontario of mother-infant dyads of live births from Jan...
2018: Canadian Journal of Rural Medicine
Isabel Atencio, Max Beushausen, John J Kowalczyk, Andres Flores-Hidalgo, Nora Fitzgerald, Dale A Baur
PURPOSE: Currently, there is a concern at the national level of the overuse of both prescription and nonprescription opioid use. The purpose of this study was to identify whether the use of the intravenous (IV) formulation of acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom) is an effective tool in the reduction of postoperative pain, with a secondary goal of reduction of postoperative narcotic use. MATERIALS AND METHODS: A total of 72 patients with previously diagnosed either partial bony or complete bony impacted third molars were selected with care to avoid long-acting local anesthetics or dissociative anesthetic agents...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Julia M Stephen, Lucinda Flynn, Danielle Kabella, Megan Schendel, Sandra Cano, Daniel D Savage, William Rayburn, Lawrence M Leeman, Jean Lowe, Ludmila N Bakhireva
Early identification of children who experience developmental delays due to prenatal alcohol exposure (PAE) remains a challenge for individuals who do not exhibit facial dysmorphia. It is well-established that children with PAE may still exhibit the cognitive and behavioral difficulties, and individuals without facial dysmorphia make up the majority of individuals affected by PAE. This study employed a prospective cohort design to capture alcohol consumption patterns during pregnancy and then followed the infants to 6 months of age...
2018: NeuroImage: Clinical
Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
John J McCarthy, Ernest J Vasti, Martin H Leamon, Joseph Graas, Coburn Ward, Catherine Fassbender
OBJECTIVES: Pregnancy profoundly alters drug metabolism, accelerating clearance and confounding medication management, primarily through induction of CYP450 enzymes. Methadone is a CYP450 substrate with altered pharmacokinetics during pregnancy. We report on the use of serum methadone/metabolite ratios (MMRs) to monitor changes in methadone metabolism through the perinatal period and to objectively guide methadone dosing. Previous research found average MMRs in nonpregnant populations of between 11...
March 7, 2018: Journal of Addiction Medicine
Enrique Gomez-Pomar, Loretta P Finnegan
Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence...
2018: Frontiers in Pediatrics
Elizabeth Yen, Jonathan M Davis
Neonatal abstinence syndrome (NAS) is a constellation of withdrawal symptoms in infants born to mothers with chronic opioid use during pregnancy. A proportion of infants will need pharmacotherapy in addition to non-pharmacological interventions. In this article, we reviewed a clinical trial comparing the use of sublingual buprenorphine to oral morphine (the most widely used pharmacotherapy for NAS) in term infants. The primary end point was the duration of treatment, and secondary end points were the length of hospital stay, the proportion of infants who needed supplemental phenobarbital, and safety...
March 7, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Amy L Haycraft
Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed...
March 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
Elizabeth E Krans, Scott D Rothenberger, Penelope K Morrison, Seo Young Park, Leah C Klocke, Mary J Turocy, Susan Zickmund
Objectives To evaluate Hepatitis C virus (HCV) knowledge and awareness among pregnant women with opioid use disorder (OUD). Methods From May through November 2015, a one-time survey was distributed to a convenience sample of pregnant women with OUD to assess their knowledge and awareness of (a) risk factors for HCV infection, (b) HCV transmission prevention strategies, (c) hepatotoxic risk reduction and (d) perinatal transmission and neonatal implications of HCV infection. Chi square and Fisher's exact tests were used to compare demographic characteristics and HCV knowledge between participants who were HCV positive and negative...
March 3, 2018: Maternal and Child Health Journal
Jacqueline M Cohen, Mollie E Wood, Sonia Hernandez-Diaz, Hedvig Nordeng
PURPOSE: Father's medication use is of interest in fertility studies and as negative control exposures in pregnancy medication safety studies. We sought to compare self-report to prescription records to understand how reliably each of these sources of information may be used. METHODS: We compared self-reported medication use in the 6 months prior to pregnancy from fathers participating in the Norwegian Mother and Child Cohort Study to records of dispensed prescriptions from the Norwegian Prescription Database that overlapped in time...
February 28, 2018: Pharmacoepidemiology and Drug Safety
Frédéric Aubrun, Noël Zahr, Olivier Langeron, Nicolas Boccheciampe, Nathalie Cozic, Lisa Belin, Jean-Sebastien Hulot, Frederic Khiami, Bruno Riou
BACKGROUND: Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES: To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics...
February 22, 2018: European Journal of Anaesthesiology
Linda Nguyen, Laura R Lander, Kevin E O'Grady, Patrick J Marshalek, Adrienne Schmidt, Audra K Kelly, Hendrée E Jones
BACKGROUND AND OBJECTIVES: Rising concerns regarding diversion and misuse of mono-buprenorphine for treatment of pregnant women with opioid use disorders have sparked interest in the use of buprenorphine + naloxone to reduce misuse and diversion rates. Examined the relationship of prenatal buprenorphine + naloxone exposure to neonatal outcomes. METHODS: This is a retrospective chart review of 26 mother infant dyads in comprehensive medication-assisted treatment with buprenorphine + naloxone during pregnancy...
March 2018: American Journal on Addictions
Elizabeth E Krans, Joo Yeon Kim, Alton Everette James, David K Kelley, Marian Jarlenski
OBJECTIVE: The purpose of this study was to describe postpartum contraceptive utilization patterns among women with OUD and evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. METHODS: A retrospective cohort study was conducted with women in Pennsylvania Medicaid with a diagnosis of OUD between 2008 and 2013. Postpartum contraceptive use within 90 days after delivery was identified through claims data and categorized by effectiveness (highly-effective, effective, and no method observed)...
February 14, 2018: Drug and Alcohol Dependence
Blanka Nechanská, Viktor Mravčík, Svetlana Skurtveit, Ingunn Olea Lund, Roman Gabrhelík, Anders Engeland, Marte Handal
BACKGROUND AND AIMS: Opioid maintenance treatment (OMT) is recommended to opioid dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. DESIGN: Nationwide register-based cohort study using personalized IDs assigned to all citizens for data linkage. SETTING: The Czech Republic (2000-2014) and Norway (2004-2013)...
February 14, 2018: Addiction
Laura J Faherty, Meredith Matone, Molly Passarella, Scott Lorch
BACKGROUND: The prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described. METHODS: Using linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15-24 years old in a mid-Atlantic city from 2007 to 2010...
February 7, 2018: Maternal and Child Health Journal
Alane B O'Connor, Brett Uhler, Liam M O'Brien, Kyle Knuppel
AIM: To determine variables related to treatment retention in women six and twelve months postpartum that were in medication treatment using buprenorphine during pregnancy. METHODS: This retrospective cohort study of 190 maternal-infant dyads exposed to buprenorphine during pregnancy examines rates of treatment retention at six and twelve months postpartum and also analyzes a variety of potential predictors of treatment retention including illicit drug use in the third trimester, delayed entry into medication treatment and co-occurring mental health diagnoses requiring prescription medication...
March 2018: Journal of Substance Abuse Treatment
Karol Kaltenbach, Kevin E O'Grady, Sarah H Heil, Amy L Salisbury, Mara G Coyle, Gabriele Fischer, Peter R Martin, Susan Stine, Hendrée E Jones
BACKGROUND: Methadone and buprenorphine are recommended to treat opioid use disorders during pregnancy. However, the literature on the relationship between longer-term effects of prenatal exposure to these medications and childhood development is both spare and inconsistent. METHODS: Participants were 96 children and their mothers who participated in MOTHER, a randomized controlled trial of opioid-agonist pharmacotherapy during pregnancy. The present study examined child growth parameters, cognition, language abilities, sensory processing, and temperament from 0 to 36 months of the child's life...
February 1, 2018: Drug and Alcohol Dependence
Thomas E Elliott, Caitlin K Frail, Pamala A Pawloski, Avis J Thomas, Ann M Werner, Rebecca C Rossom
OBJECTIVES: Determine the prevalence of opioid use before, during, and after pregnancy and describe its use based on patient-specific characteristics. Determine secular trend of opioid use 2006-2014. METHODS: Retrospective cohort study. A large Upper Midwest integrated healthcare system and insurer. Females age 10 to 50 years with a delivery diagnosis from July 1, 2006 through June 30, 2014. MAIN OUTCOME MEASURE: Prevalence of opioid use before, during, and after pregnancy; description of opioid use during these time periods...
February 5, 2018: Clinical Journal of Pain
Lara S Lemon, Ashley Naimi, Steve N Caritis, Robert W Platt, Raman Venkataramanan, Lisa M Bodnar
BACKGROUND: Pregnant women treated with methadone as opioid maintenance therapy are more likely than women treated with buprenorphine to deliver preterm. Preterm birth is associated with less risk of neonatal abstinence syndrome (NAS). We sought to assess the role of preterm birth as a mediator of the relationship between in utero exposure to methadone and NAS compared with buprenorphine. METHODS: We studied 716 women receiving methadone or buprenorphine and delivering liveborn infants at Magee-Womens Hospital, Pittsburgh, Pennsylvania (2013-15)...
January 26, 2018: Paediatric and Perinatal Epidemiology
Naana Afua Jumah, Lisa Bishop, Mike Franklyn, Janet Gordon, Len Kelly, Sol Mamakwa, Terry O'Driscoll, Brieanne Olibris, Cynthia Olsen, Natalie Paavola, Susan Pilatzke, Brenda Small, Meldon Kahan
Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women...
January 22, 2018: Canadian Journal of Public Health. Revue Canadienne de Santé Publique
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