Methadone and perinatal outcomes: a prospective cohort study

Cleary, Brian; Eogan, Maeve; O’Connell, Michael P.; Fahey, Tom; Gallagher, Paul; Clarke, Thomas A.; White, Martin; McDermott, Christine; O'Sullivan, Anne; Carmody, Deirdre; Gleeson, Justin; Murphy, Deirdre J.

doi:10.1111/j.1360-0443.2012.03844.x

Cited by 59 publications

(44 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 Duration of opioid use was defined as the period between the prescription start date and the end of the days of supply (allowing up to a 5-day carryover period from previous prescriptions). SSRI 20 has been associated with more severe NAS among opioid-exposed infants and was considered in our evaluation; however, the use of these drugs was rare in the study population (167 of 112 029) due to TennCare policies and was not included.…”

Section: Exposuresmentioning

confidence: 99%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

272

195

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS). METHODS:We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.RESULTS: Of 112 029 pregnant women, 31 354 (28%) filled $1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P , .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P , .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P , .001), opioid type (P , .001), number of daily cigarettes smoked (P , .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.CONCLUSIONS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS. WHAT'S KNOWN ON THIS SUBJECT:Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is not well described. Further, factors associated with development of neonatal abstinence syndrome, a neonatal opioid withdrawal syndrome is inadequately understood.WHAT THIS STUDY ADDS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of neonatal abstinence syndrome.

show abstract

Section: Exposuresmentioning

confidence: 99%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

272

195

View full text Add to dashboard Cite

show abstract

“…102,103 Delayed onset also is noted when opioids are used along with barbiturates or benzodiazepines. 104 In general, infants born at term, infants with good birth weight, polydrug-exposed neonates, and infants with delayed drug metabolism are more prone to severe and prolonged withdrawal. Additional risk factors for increased NAS may include maternal smoking, methadone usage, and male gender.…”

Section: Clinical Presentationmentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

View full text Add to dashboard Cite

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.

show abstract

“…A dose-response relationship between methadone and neonatal abstinence syndrome (NAS) has been reported in a large series of 618 women [24] but a meta-analysis by the same author [23] and others [25] did not confirm these findings. A recent prospective study by this group concluded that neonates exposed to methadone doses ≥ 80 mg required higher cumulative doses of morphine treatment for NAS but attributed this to concomitant use of other drugs [26]. Increased rates of congenital anomalies have been reported in nonrandomized studies, [12,24,27] but these have not yet been evaluated in randomized designs [28] capable of controlling for concomitant consumption of other substances.…”

Section: Introductionmentioning

confidence: 99%

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

Janssen¹,

Kelly²,

Thiessen³

et al. 2013

Deutsche Zeitschrift für Akupunktur

View full text Add to dashboard Cite

Background: The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns. Methods: We randomly assigned chemically dependent pregnant women at BC Women's Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care. Results: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant. Conclusions: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns. Clinical Trial Registration: http://www.clinicaltrials.gov registry: W05-0041

show abstract

Methadone and perinatal outcomes: a prospective cohort study

Abstract: The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization.

Cited by 59 publications

References 46 publications

Prescription Opioid Epidemic and Infant Outcomes

Prescription Opioid Epidemic and Infant Outcomes

Neonatal Abstinence Syndrome

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

Contact Info

Product

Resources

About