Opioid Use Disorder in Pregnancy

Roper, Van; Cox, Kim J.

doi:10.1111/jmwh.12619

Cited by 16 publications

(8 citation statements)

References 43 publications

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“…We also found that younger patients with gastroparesis were more likely to have OUD, as were females and patients with Medicaid insurance. Our finding in the gastroparesis cohort is consistent with a CDC report that showed a 4-fold increase in OUD during labor and delivery; safety measures have since been introduced to limit the maternal and neonatal complication rate [27,28]. This emphasizes the need for special attention to gastroparesis management for women of childbearing age.…”

Section: Discussionsupporting

confidence: 89%

Opioid use disorder is associated with increased mortality and morbidity in patients with gastroparesis

Siddiqui

Bilal

Schorr-Lesnick

et al. 2019

aog

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Background Opioid use disorder (OUD) epidemic has been declared a nationwide public health emergency by the Department of Health and Human Services. There are limited data regarding OUD in patients with gastroparesis. This study aimed to evaluate the impact of OUD on the outcomes in patients hospitalized with gastroparesis and to delineate the trends associated with OUD and gastroparesis using a nationally representative sample. Methods We used the National (Nationwide) Inpatient Sample database from 2005-2014 to identify patients hospitalized with a primary diagnosis of gastroparesis (ICD 9 Code: 536.3) and a concurrent diagnosis of OUD. We used Pearson chi-square analysis to compare demographics, the independent samples t-test to assess differences in length of stay and cost of care, and multivariate regression analysis to adjust for confounders. Results Between 2005 and 2014, a total of 145,700 patients with a primary diagnosis of gastroparesis were hospitalized in the United States, of whom 4519 (3.1%) had a concurrent diagnosis of OUD. The prevalence of OUD in gastroparesis doubled from 2.1% in 2005 to 4.3% in 2014. After adjusting for confounders, patients with OUD had greater in-hospital mortality (adjusted odds ratio 2.7, 95% confidence interval: 2.1-3.5). Patients with OUD also had significantly longer hospital stays and higher costs. Independent predictors of OUD in patients with gastroparesis were younger age, female sex, alcohol use, depression, and Medicaid insurance. Conclusion OUD in patients with gastroparesis is associated with greater mortality and healthcare resource utilization.

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Section: Discussionsupporting

confidence: 89%

Opioid use disorder is associated with increased mortality and morbidity in patients with gastroparesis

Siddiqui

Bilal

Schorr-Lesnick

et al. 2019

aog

View full text Add to dashboard Cite

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“…Both limited economic means and Medicaid coverage may constrain treatment options for rural residents with OUD, who also face workforce and health services shortages for both obstetric care and substance use/mental illness. 40,43 Implications While many resources dedicated to combating maternal OUD and NAS are concentrated in urban teaching hospitals, [6][7][8] we demonstrated increases in OUD and NAS diagnosis in all hospital settings, including more than half of rural residents with maternal OUD who give birth in rural hospitals. Rural hospitals may be less well equipped to handle the complex needs of this patient population.…”

Section: Discussionmentioning

confidence: 83%

“…These women and infants may require specialized and high acuity services, which are frequently limited in rural hospital settings and at hospitals with lower levels of maternal care. [6][7][8]12,14 The findings from this analysis show that clinicians in rural hospitals see substantial numbers of patients impacted by opioid-affected births as well as other clinical complications, warranting efforts to support complex patient needs in all hospital settings.…”

Section: Discussionmentioning

confidence: 92%

Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007–2014

Kozhimannil

Chantarat

Ecklund

et al. 2018

The Journal of Rural Health

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Purpose Opioid use disorder (OUD) during pregnancy is associated with poor maternal and infant outcomes, including neonatal abstinence syndrome (NAS), and both maternal OUD and NAS are increasing disproportionately among rural residents. This study describes the trajectory and characteristics associated with diagnosis of maternal OUD or NAS among rural residents who gave birth at different types of hospitals based on rural/urban location and teaching status. Methods Hospital discharge data from the all‐payer National Inpatient Sample were used to describe maternal OUD and infant NAS among rural residents from 2007–2014. Hospitals were categorized as rural, urban teaching, and urban nonteaching. We estimated incidence trends by hospital categories, followed by multivariable logistic regression analyses to identify correlates of OUD and NAS among rural residents, stratified by hospital category. Findings Incidence of maternal OUD increased in all hospital categories, with higher rates (8.9/1,000 deliveries) among rural residents who gave birth at urban teaching hospitals compared with those who gave birth at rural hospitals (4.3/1,000 deliveries) or urban nonteaching hospitals (3.6/1,000 deliveries; P < .001). A similar pattern was observed for infant NAS. In multivariable models, the association between maternal OUD and infant NAS diagnoses and hospital category differed by rurality (micropolitan vs. noncore.) Conclusions There has been a sustained increase in both maternal OUD and NAS diagnoses among rural residents. Measured sociodemographic and clinical correlates of maternal OUD and NAS differ by hospital category, indicating variability across hospital locations in patient populations and clinical needs for rural residents with these conditions.

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“…However, despite current recommendations, the majority of pregnant women with OUD do not receive pharmacotherapy during pregnancy . Roper and Cox summarized prenatal considerations for women with OUD in a review that highlighted the importance of pharmacotherapy treatment programs to avoid the risk of relapse and adverse effects on the fetus . Buprenorphine is generally preferred over methadone given its equivalent safety and efficacy as well as the increased ease by which the medication can be obtained .…”

Section: Introductionmentioning

confidence: 99%

Maternity Care for Pregnant Women with Opioid Use Disorder: A Review

Rizk

Simonsen

Roberts

et al. 2019

J Midwife Womens Health

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Opioid misuse is a problem that is complex and widespread. Opioid misuse rates are rising across all US demographics, including among pregnant women. The opioid epidemic brings a unique set of challenges for maternity health care providers, ranging from ethical considerations to the complex health needs and risks for both woman and fetus. This article addresses care for pregnant women during the antepartum, intrapartum, and postpartum periods through the lens of the opioid epidemic, including screening and counseling, an interprofessional approach to prenatal care, legal considerations, and considerations for care during labor and birth and postpartum. Providers can be trained to identify at-risk women through the evidence-based process of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and connect them with the appropriate care to optimize outcomes. Women at moderate risk of opioid use disorder can be engaged in a brief conversation with their provider to discuss risks and enhance motivation for healthy behaviors. Women with risky opioid use can be given a warm referral to pharmacologic treatment programs, ideally comprehensive prenatal treatment programs where available (a warm referral is a term used when a provider, with the patient's permission, contacts another provider or another service him or herself rather than providing a phone number and referral number). Evidence regarding care for the pregnant woman with opioid use disorder and practical clinical recommendations are provided.

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Opioid Use Disorder in Pregnancy

Cited by 16 publications

References 43 publications

Opioid use disorder is associated with increased mortality and morbidity in patients with gastroparesis

Opioid use disorder is associated with increased mortality and morbidity in patients with gastroparesis

Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007–2014

Maternity Care for Pregnant Women with Opioid Use Disorder: A Review

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