Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy

Liu, Anthony J W; Jones, Michael; Murray, Henry; Cook, Colleen M.; Nanan, Ralph

doi:10.1111/j.1479-828x.2010.01168.x

Cited by 65 publications

(47 citation statements)

References 29 publications

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“…Adverse perinatal outcomes occur at higher rates among unintended pregnancies alone [39]. Despite possible confounding due to associated comorbidities, the increase in hospital costs and adverse perinatal outcomes in the current study is likely due to neonatal abstinence syndrome and preterm deliveries as was seen in prior investigations [7, 15, 31, 40–42]. Due to a lack of sufficiently detailed data, this hypothesis could not be tested in our study.…”

Section: Discussionmentioning

confidence: 78%

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

Whiteman

Salemi

Mogos³

et al. 2014

Journal of Pregnancy

133

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Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067), compared to $4,084 (95% CI: $4,002–$4,166) for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.

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Section: Discussionmentioning

confidence: 78%

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

Whiteman

Salemi

Mogos³

et al. 2014

Journal of Pregnancy

133

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“…There was no difference in the method of feeding if delivered by cesarean section. Cesarean section was shown to be a significant confounder in a previous study (10) and was therefore included in all analyses.…”

Section: Resultsmentioning

confidence: 99%

Feeding Modalities and the Onset of the Neonatal Abstinence Syndrome

et al. 2015

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Breast milk has been reported to ameliorate the severity and outcome of neonatal abstinence syndrome (NAS). The mechanism of this beneficial effect of breast milk on NAS remains unclear, as the negligible amount of methadone transmitted via breast milk is unlikely to have an impact on NAS. The aim of this study was to compare the impact of different feeding modalities on the onset of NAS. A retrospective medical record review was conducted on 194 methadone-maintained mother/infant dyads. Infants were categorized on the first 2 days of life as predominantly breastfed, fed expressed human breast milk (EBM), or formula fed. The feeding categories were then analyzed using the onset of NAS as the outcome measure. After adjusting for confounders, there was no significant effect of the modality of feeding on the rates of NAS requiring treatment (p = 0.11). Breastfeeding significantly delayed the onset of NAS (p = 0.04). The act of breastfeeding in the first 2 days of life had no effect on whether an infant required treatment for NAS when compared to those fed EBM or formula. This only suggests that the advantages of breastfeeding on NAS cannot be substantiated in a small cohort and should not discourage breastfeeding.

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“…Elderly patients were found to be sensitive to low doses of methadone. (201)(202)(203)(204)(205)(206) Alcohol…”

Section: Metabolism and Excretionmentioning

confidence: 99%

“…Neonatal withdrawal syndrome has often been seen in babies born to women in MMT programs 204,205 . This is possibly due to increased free methadone levels.…”

Section: Agementioning

confidence: 99%

Methadone: a review of drug-drug and pathophysiological interactions

Kapur

Hutson²,

Chibber

et al. 2011

Critical Reviews in Clinical Laboratory Sciences

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Numerous established and potential drug interactions with methadone are clinically important in people treated with methadone either for addiction or for chronic pain. Methadone users often have comorbidities and are prescribed drugs that may interact with methadone. Methadone is extensively metabolized by cytochrome P450 (CYP) 3A4 and to a lesser extent by CYP 1A2, 2D6, 2D8, 2C9/2C8, 2C19, and 2B6. Eighty-six percent of methadone is protein bound, predominately to α1-acid glycoprotein (AGP). Polymorphisms in or interactions with CYPs that metabolize methadone, changes in protein binding, and other pathophysiological conditions affect the pharmacokinetic properties of methadone. It is critical for health care providers who treat patients on methadone to have adequate information on the interactions of methadone with other drugs of abuse and other medications. We set out to describe drug-drug interactions as well as physiological and pathophysiological factors that may impact the pharmacokinetics of methadone. Using MEDLINE, we conducted a systematic search for papers and related abstracts published between 1966 and June 2010. Keywords that included methadone, drug-drug interactions, CYP P450 and AGP identified a total of 7709 papers. Other databases, including the Cochrane Database of Systematic Reviews and Scopus, were also searched; an additional 929 papers were found. Final selection of 286 publications was based on the relevance of each paper to the topic. Over 50 such interactions were found. Interactions of methadone with other drugs can lead to increased or decreased methadone drug levels in patients and result in potential overdose or withdrawal, respectively. The former can contribute to methadone's fatality. Prescribers of methadone and pharmacists should enquire about any new medications (including natural products and over-the-counter medications) periodically, and especially when an otherwise stable patient suddenly experiences drug craving, withdrawal or intoxication.

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Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy

Cited by 65 publications

References 29 publications

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

Feeding Modalities and the Onset of the Neonatal Abstinence Syndrome

Methadone: a review of drug-drug and pathophysiological interactions

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