Fentanyl in the labor epidural impacts the results of intrapartum and postpartum maternal and neonatal toxicology tests

Siegel, Molly; Mahowald, Grace K.; Uljon, Sacha N.; James, Kaitlyn; Leffert, Lisa; Sullivan, Mackenzie W.; Hernandez, Susan J.; Gray, Jessica; Schiff, Davida M.; Bernstein, Sarah N.

doi:10.1016/j.ajog.2022.11.1293

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…What is beneficial for the mother may not always be so for the fetus, and vice versa. This complexity is well highlighted by the recent prospective cohort study by Siegel et al, 1 wherein the routine use of fentanyl for neuraxial analgesia in labor affected maternal and neonatal toxicology testing, a finding that, if misinterpreted, could negatively impact their care.…”

Section: Commentmentioning

confidence: 99%

Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests

Siegel,

Mahowald,

Uljon

et al. 2024

Obstetric Anesthesia Digest

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(Am J Obstet Gynecol. 2023;228(6):741.e1–741.e7) In obstetrics, toxicology testing is often used to gather data about maternal substance use. A positive maternal or neonatal toxicology test can result in significant consequences, including referrals to child protective services, dismissal from substance use treatment programs, and possibly incarceration. The aim of this study was to evaluate the impact of administering neuraxial fentanyl during labor on toxicology test outcomes for mothers and neonates.

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Section: Commentmentioning

confidence: 99%

Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests

Siegel,

Mahowald,

Uljon

et al. 2024

Obstetric Anesthesia Digest

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“…Additionally, familiarity with the hospital's method of screening, as well as false-positive/negative rates and means of confirming positives is recommended, as the documentation of these results can have significant ramifications for the patient. Finally, neuraxial fentanyl administered in the labor epidural can cause positive results on both parturient and neonatal urine drug screening, and thus, timing of collection must be clearly documented [64].…”

Section: Intrapartum Considerationsmentioning

confidence: 99%

Pharmacotherapy for opioid use disorder in pregnancy

Trammel,

Whitley,

Kelly

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Opioid use disorder (OUD) in pregnancy has significantly in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. Recent findings Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. Summary Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. Video http://links.lww.com/COOG/A94

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Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure

McMillin,

Morad,

Boyd

et al. 2024

Clinical Chemistry

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Background Substance use during pregnancy is common, as is biological testing that is intended to help identify prenatal exposures. However, there is no standardized requirement for biological testing with either maternal or newborn specimens, nor is there standardization related to when testing occurs, how frequently testing occurs, what specimen(s) to test, what substances to test for, or how to perform testing. Content We review common specimen types tested to detect maternal and newborn substance exposure with a focus on urine, meconium, and umbilical cord tissue. We also review common analytical methods used to perform testing, including immunoassay, and mass spectrometry platforms. Considerations regarding the utilization of testing relative to the purpose of testing, the drug analyte(s) of interest, the specific testing employed, and the interpretation of results are emphasized to help guide decisions about clinical utilization of testing. We also highlight specific examples of unexpected results that can be used to guide interpretation and appropriate next steps. Summary There are strengths and limitations associated with all approaches to detecting substance exposure in pregnant persons as well as biological testing to evaluate a newborn with possible substance exposure. Standardization is needed to better inform decisions surrounding evaluation of substance exposures in pregnant people and newborns. If biological sampling is pursued, testing options and results must be reviewed in clinical context, acknowledging that false-positive and -negative results can and do occur.

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Fentanyl in the labor epidural impacts the results of intrapartum and postpartum maternal and neonatal toxicology tests

Cited by 4 publications

References 21 publications

Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests

Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests

Pharmacotherapy for opioid use disorder in pregnancy

Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure

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