Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?

Moyer, Chelsie Leigh; Johnson, Sean; Klug, Marilyn G.; Burd, Larry

doi:10.5811/westjem.2018.1.35630

Cited by 12 publications

(4 citation statements)

References 13 publications

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“…The American College of Obstetrics and Gynecology (ACOG) recommends using a questionnaire to screen all pregnant women regarding drug use, however it does not recommend routine urine drug screens. Despite these recommendations there is existing data that pregnant women presenting to the ED are less likely to be tested for ETOH or drug use than non-pregnant patients 13 which is in direct contrast to our results. Similarly, with regards to Hep C, disappointingly only 47.6% of the non-pregnant and 72.7% of the pregnant patients without known hep C were screened with either Ab or PCR on presentation.…”

Section: Discussioncontrasting

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Shapero

Berlacher

Megli

2023

Preprint

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Background: The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%) with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal mortality and morbidity, and existing data on outcomes in pregnancy is limited to case reports and small studies. Our study compares the outcomes of pregnant patients with IE as compared to non-pregnant patients. Methods: Patients diagnosed with IE during pregnancy or 30 days post-partum between 2014-2021 were identified by ICD-9/10 codes. Pregnant cases were matched to a random sampling of non-pregnant reproductive-age female endocarditis patients in a 1:4 ratio. Demographic and clinical data was collected. Data was validated through chart review. Results: 180 patients with IE were identified for this cohort; 34 were pregnant or within 30 days post-partum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. Etiology of IE in pregnant patients was predominantly S. aureus (MSSA/MRSA) whereas non-pregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29% p=0.84), 2-yr mortality (20.6% vs 17.8%, p =.>0.99), and ICU admission (61.8% vs 69.8%, p=0.414) in pregnant patients. There was a trend towards higher rates of PE (17.6% vs 7.5%, p=0.098), arrhythmia (17.6% vs 9.6%, p=0.222) among pregnant patients. There were high rates of IVDU relapse in both groups (>40%). Conclusion: We observed similar rates of valve replacement, 2-year mortality, and ICU admission in both pregnant and non-pregnant patients with IE. We observed a microbial predilection for S.aureus in pregnancy suggesting that the physiology of pregnancy may select for this microbiologic etiology. These results represent the largest single center retrospective review of IE in pregnancy and suggests that pregnancy may have increased morbidity.

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Section: Discussioncontrasting

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Shapero

Berlacher

Megli

2023

Preprint

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“…The American College of Obstetrics and Gynecology (ACOG) recommends using a questionnaire to screen all pregnant women for substance use disorders. Despite these recommendations, there are existing data that pregnant women presenting to the emergency department are less likely to be tested for alcohol or drug use than nonpregnant patients [ 12 ]. Interestingly, in our study we observed much higher—although suboptimal—rates of urinary drug screening in pregnant patients (82.4% and 50.7%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

Shapero,

El-Dalati,

Berlacher

et al. 2023

Open Forum Infectious Diseases

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Background The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%), with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of mortality and morbidity, and existing data on outcomes in pregnancy are limited. Our study compares the outcomes of pregnant patients with IE with those of nonpregnant patients. Methods Patients diagnosed with IE during pregnancy and 30 days postpartum between 2014 and 2021 were identified by International Classification of Diseases, Clinical Modification, Ninth and Tenth Edition codes. Pregnant cases were matched to nonpregnant reproductive-age endocarditis patients in a 1:4 ratio. Data were collected and validated through chart review. Results One hundred eighty patients with IE were identified; 34 were pregnant or within 30 days postpartum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. The etiology of IE in pregnant patients was predominantly S. aureus (methicillin-resistant/sensitive S. aureus), whereas nonpregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29%; P = .84) and 2-year mortality (20.6% vs 17.8%; P > .99) in pregnant patients. There were nonsignificantly higher rates of pulmonary emboli (17.6% vs 7.5%; P = .098) and arrhythmia (17.6% vs 9.6%; P = .222) among pregnant patients. There were high rates of intravenous drug use relapse in both groups (>40%). Conclusions We observed similar rates of mortality in the pregnant IE patients. We observed a microbial predilection for S. aureus in pregnancy, suggesting that the pregnancy physiology may select for this microbiologic etiology. This study, which represents the largest single-center retrospective review of IE in pregnancy, suggests that surgical intervention may be performed safely in the postpartum period.

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“…This is often the case even among healthcare professionals. A recent study showed that a pregnant woman presenting to an Emergency Department is 75% less likely to be tested for drug use than a non-pregnant woman of similar age [87].…”

Section: Substance Use Disordersmentioning

confidence: 99%

“…Behavioral measures must be the focus of treatment as there is limited data on the use of drugs to treat alcohol dependence (e.g., disulfiram, naltrexone, acamprosate) during pregnancy. Physicians must carefully weigh the risks of using such drugs versus alcohol use [84,87,[94][95][96].…”

Section: Substance Use Disordersmentioning

confidence: 99%

Brazilian Psychiatric Association consensus for the management of psychiatric emergencies in pregnancy and postpartum period

Baldaçara

Rocha²,

Pinto

et al. 2022

Debates em Psiquiatria

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Introduction: Emergencies in the pregnancy and postpartum are less frequent than in other groups, but not uncommon. However, the literature on the subject is scarce and controversial. Objective: The objective of this article is to present some recommendations for the management of the most common psychiatric emergencies that may occur in pregnancy or postpartum period. Method: These procedures were focused on the discussion and integration of the findings from peer-reviewed published research on the topic. We searched electronic database PubMed. Relevant abstracts were identified using the following search terms: Psychotropics medications at pregnancy and breastfeeding: (((psychotropic medications) AND (pregnancy)) OR (psychotropic medications)) AND (breastfeeding) - Psychiatric emergencies: (((((((psychiatric emergencies) AND (pregnancy)) OR (psychiatric emergencies)) AND (postpartum)) OR (psychiatric emergencies)) AND (peripartum)) OR (psychiatric emergencies)) AND (breastfeeding). Inclusion criteria included papers published (or in press) about pregnancy or breastfeeding or postpartum from December 2000 to January 2021 that focused on agitation in psychiatric emergencies. Main Results: We present recommendation for pharmacological treatment, psychomotor agitation, suicide behavior, psychotic disorders and mania, severe depression, and substance use disorders. Conclusion: Although many of the recommendations are empirical, it is already possible to rely on information that provides better results and safety for the patient and her infant.

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Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?

Cited by 12 publications

References 13 publications

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

Brazilian Psychiatric Association consensus for the management of psychiatric emergencies in pregnancy and postpartum period

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