Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence

Sutter, Mary Beth; Gopman, Sarah; Leeman, Lawrence

doi:10.1016/j.ogc.2016.11.004

Cited by 76 publications

(63 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sociodemographic correlates of maternal OUD and NAS among rural residents largely reinforce patterns uncovered in prior research . For example, in this study, we found an elevated risk of OUD diagnosis among rural pregnant patients with mental illness, tobacco use, and/or a chronic pain diagnosis, regardless of delivery hospital location and teaching status.…”

Section: Discussionsupporting

confidence: 85%

“…Sociodemographic correlates of maternal OUD and NAS among rural residents largely reinforce patterns uncovered in prior research. 3,7,33,35,36 For example, in this study, we found an elevated risk of OUD diagnosis among rural pregnant patients with mental illness, tobacco use, and/or a chronic pain diagnosis, regardless of delivery hospital location and teaching status. Diagnosis of mental illness (depression, anxiety, or severe mental illness) emerged as the correlate of maternal OUD with the largest odds ratio, consistent with prior research on co-occurrence of mental illness and substance use disorder during pregnancy.…”

Section: Discussionmentioning

confidence: 49%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 49%

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

View full text Add to dashboard Cite

show abstract

“…Additional variables such as educational attainment, socioeconomic status, housing stability, and social support could not be consistently captured for the entire cohort, although they have been show to impact EI enrollment. 14,42,43 Future prospective and longitudinal studies could assess the association of these psychosocial factors, well child care attendance, and ongoing developmental or medical problems with EI enrollment over the time period of EI eligibility.…”

Section: Limitationsmentioning

confidence: 99%

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Peacock-Chambers

Leyenaar

Foss

et al. 2019

J Dev Behav Pediatr

View full text Add to dashboard Cite

Objective: To identify factors associated with referral and enrollment in early intervention (EI) for infants with neonatal abstinence syndrome (NAS). Methods: We conducted a retrospective cohort study of 256 infants born with NAS (2006-2013) at a tertiary care hospital in (Springfield), Massachusetts, linking maternal-infant birth hospitalization records with Department of Public Health EI records. We calculated the percent of infants retained at each step in the EI enrollment process over the first 3 years of life. We conducted separate multivariable logistic regression analyses to identify factors associated with EI referral and enrollment. Results: Among mothers, 82% received medication-assisted treatment at delivery, 36% endorsed illicit drug use during pregnancy, and 76% retained custody of their child at discharge. Among infants, 77% were referred to EI and 48% were enrolled in services. Of infants discharged to biological parents, 81% were referred to EI versus 66% of infants discharged to foster care (p ≤ 0.05); this difference persisted in multivariable analysis [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09-4.86]. Infants in the highest tertile for length of stay had 2.70 times the odds of EI enrollment (95% CI, 1.37-5.31). Conclusion: Fewer than half of the eligible infants with NAS were enrolled in EI services. Discharge to a biological parent and longer hospital stay had the strongest associations with EI referral and enrollment, respectively. Efforts to improve EI referral rates during the birth hospitalization, particularly among infants discharged into foster care, and close follow-up for

show abstract

“…with high‐risk opioid use, as they may need more intensive management than brief intervention alone. Available information suggests that among pregnant women, receipt of interprofessional services that integrate maternity and addiction care in one setting may result in improved retention in prenatal care, increased gestational length and birth weight, reduction in intravenous injection risk behaviors (needle sharing), and fewer urine screens with results for drugs . In a study of 49,985 women screened for substance abuse in the Kaiser Permanente system, those who screened positive and received integrated substance abuse treatment and prenatal care were less likely to have a low‐birth‐weight newborn (adjusted odds ratio [aOR], 1.8; 95% CI, 1.1‐3.1), preterm birth (aOR, 2.1; 95% CI, 1.3‐3.2), or intrauterine fetal demise (aOR, 16.2; 95% CI, 6.0‐43.8) compared with those who screened positive based on a urine toxicology screen but did not receive care through such a program …”

Section: Antepartum Managementmentioning

confidence: 99%

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

Rizk

Simonsen

Roberts

et al. 2019

J Midwife Womens Health

View full text Add to dashboard Cite

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.

show abstract

Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence

Cited by 76 publications

References 59 publications

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

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

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

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

Contact Info

Product

Resources

About