Chapter 8: Caring for the Pregnant Woman with Opioid Use Disorder and Infants with Neonatal Abstinence Syndrome

2018 ◽  
pp. 125-144
Keyword(s):  
Pregnant Woman ◽  
Opioid Use Disorder ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Opioid Use

A retrospective, observational study on medication for opioid use disorder during pregnancy and risk for neonatal abstinence syndrome

2021 ◽  
Author(s):  
Ayesha Sujan ◽  
Emma Cleary ◽  
Edie Douglas ◽  
Rubin Aujla ◽  
Lisa Boyars ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Clinical Sample ◽  
Opioid Use Disorder ◽  
Additional Benefit ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Opioid Use ◽  
Relative Safety ◽  
Increased Risk ◽  
Exposure During Pregnancy

Abstract Objectives The prevalence of opioid use disorder (OUD) among pregnant women is increasing. Research consistently demonstrates the efficacy of medications for OUD (MOUD); however, researchers have called for additional studies evaluating the safety of MOUD during pregnancy, particularly the relative safety of two commonly used MOUD medications—methadone and buprenorphine. This study aimed to evaluate the consequences of MOUD exposure during pregnancy on risk for neonatal abstinence syndrome (NAS). Methods In a clinical sample of infants born to women with OUD, we evaluated the risk of NAS among those exposed to (i) methadone and (ii) buprenorphine compared with those unexposed to MOUD, as well as the risk of NAS among those exposed to (i) methadone compared with those exposed to (ii) buprenorphine. Results Compared with buprenorphine-exposed infants (n = 37), methadone-exposed infants (n = 27) were at increased risk for NAS (odds ratio [OR] = 4.67, 95% confidence interval [CI]: 1.03, 21.17). Compared with unexposed infants (n = 43), buprenorphine-exposed infants were at decreased risk for NAS (OR = 0.45, 95% CI: 0.14, 1.39) and methadone-exposed infants were at increased risk for NAS (OR = 2.64, 95% CI: 0.79, 8.76), though these associations were not statistically significant. Conclusions Our study suggests that when methadone and buprenorphine are equally appropriate options for the treatment of OUD in pregnant women, buprenorphine may add the additional benefit of reduced risk of newborn NAS.

scholarly journals A state-level study of opioid use disorder treatment access and neonatal abstinence syndrome

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth R. Wolf ◽  
Sebastian T. Tong ◽  
Roy T. Sabo ◽  
Steven H. Woolf ◽  
Kassie Abbinanti ◽  
...  
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Illicit Drug ◽  
State Level ◽  
Opioid Use Disorder ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Opioid Use ◽  
Treatment Access ◽  
Disorder Treatment

Abstract Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS. Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of NAS was defined as ICD-9 code 779.5 (drug withdrawal syndrome in newborn) from any discharge diagnosis field per 1000 live births in that state. Results Unmet need for substance use disorder treatment correlated with NAS (r = 0.54, 95% CI: 0.26–0.73). The correlation between adult illicit drug use/dependence and NAS was higher in states with a lower density of buprenorphine-waivered physicians and individuals in OTPs. Conclusions Measures of opioid use disorder treatment access dampened the correlation between illicit drug use/dependence and NAS. Future studies using community- or individual-level data may be better poised to answer the question of whether or not opioid use disorder treatment access improves NAS relative to adult opioid use.

Comparison of buprenorphine and methadone in the management of maternal opioid use disorder in full term pregnancies

2020 ◽  
Vol 48 (7) ◽  
pp. 677-680
Author(s):  
Cara L. Staszewski ◽  
Diana Garretto ◽  
Evan T. Garry ◽  
Victoria Ly ◽  
Jay A. Davis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Mode Of Delivery ◽  
Opioid Use Disorder ◽  
Neonatal Abstinence Syndrome ◽  
P Value ◽  
Abstinence Syndrome ◽  
Opioid Use ◽  
Term Infants ◽  
Medication Assisted Treatment ◽  
Methadone Group

AbstractObjectivesTo compare pregnancy outcomes with medication assisted treatment using. methadone or buprenorphine in term mothers with opioid use disorder.MethodsA cohort of women receiving medication assisted treatment with either methadone or buprenorphine were identified from delivery records over a 10‐year period. Women were excluded with delivery <37 weeks, multiple gestations, or a known anomalous fetus. Maternal demographics, medications, mode of delivery, birthweight, newborn length of stay, and neonatal abstinence syndrome were extracted. The study was IRB approved and a p-value of <0.05 was significant.ResultsThere were 260 women, 140 (53.8%) with methadone use and 120 (46.2%) with buprenorphine use. Groups were similar for maternal age, race, parity, homeless rate, tobacco use, mode of delivery and incidence of neonatal abstinence syndrome. The methadone group had a lower mean newborn birthweight (2874±459 g) and a greater incidence of low birth weight (11.4%) than the buprenorphine group (3282±452 g; p<0.001 and 2.5%; p=0.006). The incidence of neonatal abstinence syndrome was similar between groups (97% methadone vs. 92.5% buprenorphine; p=0.08). The methadone group had a longer newborn length of stay (11.4+7.4 days) and more newborn treatment with morphine (44.6%) than the buprenorphine group (8.2+4.4 days; p<0.001 and 24.2%; p<0.001). Maternal methadone use was an independent predictor for a newborn length of hospital stay >7 days (OR 3.61; 95% confidence interval 1.32–9.86; p=0.01).ConclusionsMedication assisted treatment favors buprenorphine use when compared to. methadone with an increased birthweight, reduced need for newborn treatment, and a shorter newborn length of stay in term infants.

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