Pregnancy and substance abuse

Fischer, Gabriele; Bitschnau, Micha; Peternell, A.; Eder, Harald; Topitz, A.

doi:10.1007/s007370050037

Cited by 25 publications

(22 citation statements)

References 43 publications

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“…Methadone detoxification involves using tapering doses of methadone to create a smooth transition from heroin use to a drug-free state. Withdrawal from methadone during pregnancy is not generally recommended in the literature, [3][4][5] except in specific situations such as when a motivated patient expresses a wish to withdraw from all opiates, or when methadone maintenance is unavailable -a state of affairs that is prevalent across all SA public treatment facilities.…”

Section: Researchmentioning

confidence: 99%

“…While guidance is scarce, the prevailing opinion is that methadone maintenance is the gold standard of treatment in pregnancy. [3][4][5] This option is not available in SA state RESEARCH facilities, where only methadone withdrawal is offered. It is therefore useful to review the data in the literature on the efficacy of methadone withdrawal in pregnancy.…”

Section: Researchmentioning

confidence: 99%

“…[4,5] This view is largely the result of two influential case reports published in the 1970s. Rementeria and Nunag [5] described a stillbirth at term following acute methadone withdrawal, and Zuspan et al [18] described a case of increased amniotic fluid epinephrine levels during methadone withdrawal, which resolved once the methadone dose was increased.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Gilfillan¹,

Dannatt

Stein

et al. 2018

S Afr Med J

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Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector. Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010. Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files. Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery. Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study.

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Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

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Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Gilfillan¹,

Dannatt

Stein

et al. 2018

S Afr Med J

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“…3 Intermittent therapeutic use has not demonstrated significant negative impact on maternal health. Oral opioids such as oxycodone are frequently prescribed for pain during pregnancy and delivery.…”

Section: Medical Risks Of Opioids In Pregnancymentioning

confidence: 99%

“…3–5 Challenges in the management of this patient population include the medical risks of illicit substance use in pregnancy, psychological comorbidity, and the psychosocial stressors that frequently interfere with prenatal treatment and addiction recovery. Despite these obstacles, pregnant women can be highly motivated to reduce substance use and most women strive for healthier pregnancy, providing a unique window of opportunity for intervention in this population.…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Management of Opioid Dependence in Pregnancy

2012

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Background Opioid use disorders are a growing public health problem in the United States. Most women who are opioid dependent are of childbearing age and management of opioid dependence during pregnancy poses unique challenges. Assessment includes evaluation for addiction, withdrawal syndromes, and co-morbid psychiatric diagnoses. Consultation-liaison psychiatrists may also be involved in acute pain management, perinatal medication management, buprenorphine induction and stabilization. For the past four decades, the standard of care has included methadone maintenance, but the increasing use of buprenorphine creates new treatment issues and opportunities. Objective To educate consultation-liaison psychiatrists in emergency and obstetrical settings about the appropriate approach toward the evaluation and basic management of women with opioid dependence in pregnancy. Method The authors reviewed the consensus literature and all new treatment options on opioid dependence during pregnancy. Discussion In this review, the authors summarize known and emerging management strategies for opioid dependence in pregnancy pertinent to consultation-liaison psychiatrists.

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Risk Factors for Adverse Outcomes in Developed Countries: Role of Intrauterine Growth Restriction

Bansil

Kuklina

2011

Handbook of Growth and Growth Monitoring in Health and Disease

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Pregnancy and substance abuse

Cited by 25 publications

References 43 publications

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Evaluation and Management of Opioid Dependence in Pregnancy

Risk Factors for Adverse Outcomes in Developed Countries: Role of Intrauterine Growth Restriction

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