Histological Changes Observed in Placentas Exposed to Medication-Assisted Treatment

Introduction. To compare the effects of medication-assisted treatment on the placenta in pregnant women with opioid use disorder and uncomplicated pregnancies. Methods. This is a case-controlled study of pregnant women utilizing medication-assisted treatment, buprenorphine or methadone, which were matched to healthy uncomplicated controls by gestational age. Placental evaluations and neonatal outcomes were evaluated. Data analysis performed standard statistics and relative risk analysis with a p < 0.05 considered significant. Results. There were 143 women who met the inclusion criteria: 103 utilizing MAT, 41 buprenorphine and 62 methadone, and 40 uncomplicated matched healthy controls. The incidence of delayed villous maturation was 36% in the medication-assisted group compared with 10% in controls (RR 3.6: 95% CI 1.37-9.43; p < 0.01 ). The placental weight was greater ( 541 ± 117 g versus 491 ± 117 g; p = 0.02 ), and the fetoplacental weight ratio was lower ( 5.70 ± 1.1 versus 7.13 ± 1.4 ; p < 0.01 ) in the medication-exposed pregnancies compared with controls. The mean birth weight of the MAT newborns was significantly lower than that of the healthy controls ( 3018 ± 536 g versus 3380 ± 492 g; p < 0.01 ). When evaluating the subgroups of the MAT newborns, the birth weight of the methadone-exposed newborns ( 2886 ± 514 g) was significantly lower than that of the buprenorphine-exposed newborns ( 3218 ± 512 g; p < 0.01 ). Conclusion. Medication-exposed pregnancies have a greater incidence of delayed villous maturation, a larger placental size, and a decreased fetoplacental weight ratio compared to the healthy controls. Larger long-term follow-up studies to evaluate outcomes with the presence of delayed villous maturation are needed.

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Hospital Care of Opioid-Exposed Newborns: Clinical and Psychosocial Challenges

Journal of Hospital Medicine ◽

10.12788/jhm.3369 ◽

2020 ◽

Vol 15 (10) ◽

pp. 613-618

Author(s):

Neera K Goyal ◽

Jennifer McAllister

Keyword(s):

Pregnant Women ◽

Neonatal Intensive Care ◽

Discharge Planning ◽

Hospital Costs ◽

Opioid Use Disorder ◽

Care Utilization ◽

Opioid Use ◽

Maternal Experience ◽

Medication Assisted Treatment ◽

Experience Of Care

In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.

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Opioids and the developing brain: time to rethink perinatal care for infants of opioid-dependent mothers

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320102 ◽

2021 ◽

pp. fetalneonatal-2020-320102

Author(s):

James P Boardman ◽

Helen Mactier ◽

Lori A Devlin

Keyword(s):

Perinatal Care ◽

Opioid Use Disorder ◽

Visual Development ◽

Opioid Use ◽

Health Crisis ◽

Long Term Follow Up ◽

And Function ◽

Opioid Withdrawal Syndrome ◽

Infant Brain Development

Illicit use of opioids is a global health crisis with major implications for women and children. Strategies for managing opioid use disorder (OUD) in pregnancy have been tested over the past 40 years, but studies have focused on maternal and pregnancy outcomes, with less attention given to long-term follow-up of exposed children. Here, we provide a narrative review of recent advances in the assessment and management of neonatal opioid withdrawal syndrome (NOWS), and we summarise evidence from multiple domains—neuroimaging, electrophysiology, visual development and function, neurodevelopment, behaviour, cognition and education—which suggests that prenatal opioid exposure modifies child development. Further studies are required to determine the optimal management of pregnant women with OUD and babies with NOWS. We identify knowledge gaps and suggest that future study designs should evaluate childhood outcomes, including infant brain development and long-term neurocognitive and visual function.

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The Spiritual and Ethical Implications of Medication-Assisted Recovery in Pregnancy: Preserving the Dignity and Worth of Mother and Baby

Social Work & Christianity ◽

10.34043/swc.v46i3.82 ◽

2019 ◽

Vol 46 (3) ◽

Cited By ~ 1

Author(s):

Cayce Watson ◽

April Mallory ◽

Amy Crossland

Keyword(s):

Pregnant Women ◽

Work Practice ◽

Social Work Practice ◽

Opioid Use Disorder ◽

Current Evidence ◽

Opioid Use ◽

Community Based Interventions ◽

Medication Assisted Treatment ◽

Ethical Implications ◽

In Pregnancy

Reducing harm, supporting autonomy, and affirming dignity are foundational values in social work practice. Attempts to balance personal beliefs, faith, and ethical responsibilities with client-centered therapies can elicit internal conflicts for practitioners. These challenges are even more evident when working with opioid dependent pregnant women in medication-assisted recovery. Medication-assisted treatment (MAT) is evidence-based and a recommended first-line approach for treating opioid use disorder in pregnancy; however, neonates exposed to opiates, either street drugs or MAT, may develop neonatal abstinence syndrome (NAS). Disagreement among treatment providers, insufficient resources for pregnant clients, and incomplete service delivery compound the stigma surrounding pregnant women living with opioid misuse. This article explores current evidence and best practices for pregnant women with opioid use disorder, the spiritual and ethical dilemmas of social workers supporting a harm reduction approach, and recommendations for individual and community-based interventions that support the dignity and worth of both mother and baby.

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Treating Tobacco Use Disorder in Pregnant Women in Medication-Assisted Treatment for an Opioid Use Disorder: A Systematic Review

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2014.12.002 ◽

2015 ◽

Vol 52 ◽

pp. 40-47 ◽

Cited By ~ 23

Author(s):

Sarah C. Akerman ◽

Mary F. Brunette ◽

Alan I. Green ◽

Daisy J. Goodman ◽

Heather B. Blunt ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Tobacco Use ◽

Opioid Use Disorder ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Tobacco Use Disorder

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Opioid use disorder in pregnancy: Leveraging provider perceptions to inform comprehensive treatment

10.21203/rs.3.rs-24823/v2 ◽

2020 ◽

Author(s):

Doris Titus-Glover ◽

Fadia T Shaya ◽

Christopher Welsh ◽

Danya M Qato ◽

Savyasachi Shah ◽

...

Keyword(s):

Pilot Study ◽

Pregnant Women ◽

Opioid Use Disorder ◽

Comprehensive Treatment ◽

Research Approach ◽

Opioid Use ◽

Treatment Delivery ◽

Provider Perceptions ◽

Medication Assisted Treatment ◽

Emerging Themes

Abstract Background: Medication-assisted treatment is recommended for pregnant women with opioid use disorder (OUD), yet only 50% receive the treatment. Knowledge deficit, limited access to prescribing providers, and complex delivery models are known barriers to treatment. Strategies for improvement of medication-assisted treatment during pregnancy require multi-disciplinary provider input. The objective of this study is to explore provider perceptions and factors critical to medication-assisted treatment delivery for pregnant women with OUD. Methods: A qualitative research approach was used to gather data from individual provider and group semi-structured interviews. Providers (n=12) responded to questions in several domains related to perceptions of medication-assisted treatment, treatment delivery, access to resources, and challenges/barriers. Data were collected, transcribed, coded (by consensus) and emerging themes were analyzed using grounded theory methodology. Results: Emerging themes in this pilot study, revealed persistent provider knowledge/training gaps, inadequate service coordination, inconsistent treatment guidelines, stigmatization, and lack of resources such as housing and transportation. Providers found medication-assisted treatment offered pregnant women with OUD, a “lifeline.” Conclusions: In this pilot study, we conclude that, MAT variances can be improved by leveraging healthcare provider perceptions, direct experiences and recommendations towards a team-based, patient-centered integrated approach.

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