Maintenance agonist treatments for opiate dependent pregnant women

Minozzi, Silvia; Amato, Laura; Vecchi, Simona; Davoli, Marina

doi:10.1002/14651858.cd006318.pub2

Cited by 99 publications

(41 citation statements)

References 36 publications

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“…Variables influencing fetal growth and gestational age at delivery include smoking, multiple drug use and low socioeconomic status: all factors being prevalent in SMM in the present and previous studies (Cleary et al;, Fischer & Kopf, 2007, Simpson, 1957. While heroin has been associated with retarded fetal growth (Bada et al 2002, Minnes et al;2011, Minozzi et al;2008), the use of methadone has been shown to be associated with higher birth weights when compared to women who continued to use heroin. It has further been shown to HELP prevent premature labour so that fetuses exposed to methadone had a higher birth weight and less morbidity than heroin exposed babies (Finnegan et al;2010).…”

Section: Discussionsupporting

confidence: 50%

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

Vella

Savona‐Ventura

Wolff

2015

Journal of Obstetrics and Gynaecology

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Section: Discussionsupporting

confidence: 50%

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

Vella

Savona‐Ventura

Wolff

2015

Journal of Obstetrics and Gynaecology

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“…49 A recent meta-analysis did not favor one over the other. 50 No relationship has been found between maternal opioid dose and NAS. 51 Neither methadone nor buprenorphine were approved for use in pregnancy.…”

Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…This preference largely stems from longer experience with this medication. Several studies have shown improved retention in care with methadone compared to buprenorphine, both in the general population (though this effect may not be seen with fixed high doses of buprenorphine) [18] and specifically within the pregnant population [19]. Despite these distinctions, buprenorphine offers several advantages over methadone, which can be broadly categorized into those based on the medication's intrinsic properties and those based on its delivery system.…”

Section: Buprenorphine Versus Methadone (And Naltrexone) In Pregnancymentioning

confidence: 99%

Buprenorphine with, or without, Naloxone for Pregnant Women?–Review of Current Evidence and Practice in Massachusetts

Kršák¹,

Trowbridge²,

Regan³

et al. 2017

J Alcohol Drug Depend

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Opioid use disorder has reached the level of an epidemic. Potential complications of unsafe injections, lifestyle, overdose and withdrawal are particularly concerning in pregnant women as the risk therein extends also to the foetus. The main medications in treatment of opioid use disorder are methadone, naltrexone and buprenorphine products. Naloxone (pregnancy class: B) was carefully selected to be a part of Suboxone ® in 4:1 ratio to buprenorphine (pregnancy class: C) as a deterrent for intravenous use. Naloxone's bioavailability, delivered sublingually, is minimal (<10%) yet there is a theoretical concern that a potential precipitated withdrawal could incite premature labor and fetal demise. For this reason, it is recommended that buprenorphine be used alone in this setting. However, a limited amount of data exists, showing relative safety of this combination in pregnant women when compared to other alternatives. Furthermore, current evidence in non-pregnant individuals shows that the risk of withdrawal due to naloxone is in most instances insignificant. The merit of adding naloxone as a disincentive for injecting opioids has been debated, yet the significance of preventing maternal and fetal exposures to the risk of blood stream infections, sepsis, blood-borne pathogens, bleeding and other complications is clear and warrants focused consideration. In Massachusetts, the state health insurer requires prior authorization for all forms of buprenorphine other than buprenorphine/naloxone combination films, which further complicates access to care specifically in pregnancy. Waiting periods and treatment interruptions rather than naloxone are thus much more likely to cause adverse outcomes in this population.

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Maintenance agonist treatments for opiate dependent pregnant women

Cited by 99 publications

References 36 publications

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

Neonatal Abstinence Syndrome

Buprenorphine with, or without, Naloxone for Pregnant Women?–Review of Current Evidence and Practice in Massachusetts

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