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Aflaki K, Ray JG, Edwards W, Scott H, Arbour L, Darling EK, Moore A, Dzakpasu S. Maternal deaths by suicide and drug overdose in two Canadian provinces; retrospective review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024:102581. [PMID: 38852810 DOI: 10.1016/j.jogc.2024.102581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE To identify and review factors associated with maternal deaths by suicide and drug overdose in the Canadian Coroner and Medical Examiners Database (CCMED), from 2017-2019. METHODS We identified potential maternal deaths in Ontario and British Columbia by searching the CCMED narratives of deaths to females 10 to 60 years old for pregnancy-related terms. Identified narratives were then qualitatively reviewed in quadruplicate to determine if they were maternal deaths by suicide or drug overdose, and to extract information on maternal characteristics, the manner of death, and factors associated with each death. RESULTS Of the 90 deaths identified in this study, 15 (16.7%) were due to suicide and 20 (22.2%) were due to a drug overdose. These deaths occurred to women of varying ages and across the pregnancy-postpartum period. Among the suicides, 10 were by hanging, and among the overdose-related deaths, 15 had fentanyl detected. Notably, 13 (37.1%) of the 35 deaths to suicide or drug overdose occurred beyond 42 days after pregnancy, 19 (54.3%) followed a miscarriage or induced abortion, and in 23 (65.7%) there was an established history of mental health illness. Substance use disorders were documented in 4 of the 15 suicides (26.7%), and 18 of the 20 overdose-related deaths (90.0%). CONCLUSION Suicide and drug overdose may contribute more to maternal deaths in Canada than previously realized. Programs are needed to identify women at risk of these outcomes, and to intervene during pregnancy and beyond the conventional postpartum period.
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Affiliation(s)
- Kayvan Aflaki
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Joel G Ray
- Departments of Medicine and Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Canada
| | - Wesley Edwards
- Department of Anesthesia and Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Heather Scott
- Department of Obstetrics and Gynaecology, IWK Health Center, Halifax, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of Victoria, Victoria, Canada
| | - Elizabeth K Darling
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Aideen Moore
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - Susie Dzakpasu
- Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Canada.
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Doernberg M, Gilstad-Hayden K, Yonkers KA, Forray A. Provider-patient relationships and trauma among pregnant patients with opioid-use disorder. Am J Addict 2024. [PMID: 38685767 DOI: 10.1111/ajad.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The provider-patient relationship is integral to medical practice and health outcomes, particularly among vulnerable patient populations. This study compared the provider-patient relationship among pregnant patients with opioid-use disorder (OUD), who did or did not have a history of moderate to severe trauma. METHODS This was an exploratory data analysis of 119 patients enrolled in the Support Models for Addiction Related Treatment trial. Probable posttraumatic stress disorder (PTSD) was determined by a score ≥ 31 on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The provider-patient relationship was assessed at 26 ± 4 weeks of pregnancy using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD. RESULTS The mean KAS score for pregnant participants without probable PTSD (N = 88) was 61.4 (SD ± 2.8) and for pregnant participants with probable PTSD (N = 31) was 59.6 (SD ± 3.7). Results demonstrated significant differences in KAS scores between those with and without probable PTSD after adjusting for demographic variables. Adjusted mean total KAS scores and scores on Empowerment and Communication subscales were significantly lower among those with probable PTSD compared to those without (p = .04 and 0.02, respectively) but did not differ significantly on Collaboration and Integration subscales. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Analyses show an association between probable PTSD and provider-patient relationship among pregnant patients with OUD, with those with probable PTSD having a worse alliance with obstetric providers. This novel finding helps characterize the provider-patient relationship among a uniquely vulnerable population and can inform efforts to integrate trauma-informed practices into prenatal care.
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Affiliation(s)
| | | | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Evans K, Wu P, Mamas MA, Irwin C, Kang P, Perlow JH, Foley M, Gulati M. Substance Use in Pregnancy and its Association With Cardiovascular Events. JACC. ADVANCES 2023; 2:100619. [PMID: 38938361 PMCID: PMC11198094 DOI: 10.1016/j.jacadv.2023.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 06/29/2024]
Abstract
Background Substance use and cardiovascular (CV) events are increasing among pregnant women in the United States, but association between substance use in pregnancy and CV events remains unknown. Objectives The purpose of this study was to examine the association between substance use and acute CV events in pregnancy. Methods We identified all women with a delivery hospitalization between 2004 and 2018 in the Nationwide Inpatient Sample, stratified on the presence or absence of substance use. The primary outcome was any acute CV event, defined as the presence of: acute myocardial infarction, stroke, arrhythmia, endocarditis, acute cardiomyopathy or heart failure, or cardiac arrest. Secondary outcomes were individual acute CV events, major adverse cardiac events, and maternal mortality. The association between substance use and outcomes were examined using multivariable logistical regression. Results A total of 60,014,368 delivery hospitalizations occurred from 2004 to 2018, with substance use complicating 955,531 (1.6%) deliveries. Substance use was independently associated with CV events (adjusted odds ratio [aOR]: 1.61; 95% CI: 1.53-1.70; P < 0.001), major adverse cardiac events (aOR: 1.53; 95% CI: 1.46-1.61; P < 0.001), and maternal mortality (aOR: 2.65; 95% CI: 2.15-3.25; P < 0.001) during delivery hospitalization. All individual substances had an increased association with CV events; however, amphetamine/methamphetamine had the strongest association (aOR: 2.71; 95% CI: 2.35-3.12; P < 0.001). All substances other than cocaine and cannabis had a significant association with maternal death. Conclusions Substance use has a strong association with acute CV events and maternal mortality during hospitalization for delivery and women with substance use warrant increased surveillance for CV events during this time.
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Affiliation(s)
- Kari Evans
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Pensée Wu
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Mamas A. Mamas
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Chase Irwin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Paul Kang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Jordan H. Perlow
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Michael Foley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ukah UV, Potter BJ, Paradis G, Low N, Ayoub A, Auger N. Cocaine and the Long-Term Risk of Cardiovascular Disease in Women. Am J Med 2022; 135:993-1000.e1. [PMID: 35472377 DOI: 10.1016/j.amjmed.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women. METHODS We analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization. RESULTS The cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72). CONCLUSIONS Women with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.
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Affiliation(s)
- U Vivian Ukah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Brian J Potter
- Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Quebec, Canada; University of Montreal Hospital Research Centre, Quebec, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Quebec, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec, Canada.
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Ndanga M, Sulley S, Saka AK. Trend Analysis of Substance Use Disorder During Pregnancy. Cureus 2022; 14:e23548. [PMID: 35494976 PMCID: PMC9045802 DOI: 10.7759/cureus.23548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: This study aims to analyze the trends in substance use among pregnant women in the United States. Methodology: In this retrospective study, we utilized the National Inpatient Sample (NIS) dataset sponsored by the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare Cost and Utilization Project (HCUP). Major Diagnostic Category (MDC) 14 (Pregnancy, Childbirth, and the Puerperium) and International Classification of Disease (ICD 10) codes were used to identify pregnancy-related diagnoses and presentations with any of the substance use disorder (SUD) indicators that met the inclusion criteria among the birthing population in the NIS dataset (2016-2018). We analyzed the demographic and regional characteristics between 2015 and 2018. Results: Among the population, a total of 23,475 (2.7%) had a primary or secondary diagnosis of SUD, and 851,428 (97.3%) did not. In the study group of 332,275 (2.8%) that met the inclusion criteria, 12,750 (0.1%) use alcohol, 108,960 (0.9%) had opioid use disorder (OUD), 171,490 (1.4%) use cannabis, 6,375 (0.1%) use sedatives, 28,075 (0.2%) use cocaine, 48,765 (0.4%) use other stimulants, 1,155 (0%) use hallucinogens, 115 (0%) use inhalants, and 23,950 (0.2%) had other psychoactive diagnosis. Further analysis comparing the risk of severity and mortality at presentation, procedure type, delivery method, and cost of care shows statistically significant differences (p < 0.005) between the study and control groups. Conclusion: The current trends necessitate a further assessment and implementation of comprehensive community-based treatment programs tailored to the most frequent regional SUD presentations, which could aid in mitigating drug use during pregnancy.
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Chaillon A, Wynn A, Kushner T, Reau N, Martin NK. Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States. Clin Infect Dis 2021; 73:e3355-e3357. [PMID: 32282879 PMCID: PMC8563211 DOI: 10.1093/cid/ciaa362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
To inform proposed changes in hepatitis C virus (HCV) screening guidelines in the United States, we assessed the cost-effectiveness of HCV antenatal rescreening for women without evidence of HCV during a prior pregnancy, using a previously published model. Universal HCV rescreening among pregnant women was cost-effective (incremental cost-effectiveness ratio, $6000 per quality-adjusted life-year) and should be recommended nationally.
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Affiliation(s)
- Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Tatyana Kushner
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nancy Reau
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Wen X, Wang S, Lewkowitz AK, Ward KE, Brousseau EC, Meador KJ. Maternal Complications and Prescription Opioid Exposure During Pregnancy: Using Marginal Structural Models. Drug Saf 2021; 44:1297-1309. [PMID: 34609720 DOI: 10.1007/s40264-021-01115-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prescription opioids are frequently used for pain management in pregnancy. Studies examining perinatal complications in mothers who received prescription opioids during pregnancy are still limited. OBJECTIVES The aim of this study was to assess the association of prescription opioid use and maternal pregnancy and obstetric complications. METHODS This retrospective cohort study with the Rhode Island (RI) Medicaid claims data linked to vital statistics throughout 2008-2015 included pregnant women aged 12-55 years with one or multiple live births. Women were excluded if they had cancer, opioid use disorder, or opioid dispensing prior to but not during pregnancy. Main outcomes included adverse pregnancy and obstetric complications. Marginal Structural Cox Models with time-varying exposure and covariates were applied to control for baseline and time-varying covariates. Analyses were conducted for outcomes that occurred 1 week after opioid exposure (primary) or within the same week as exposure (secondary). Sensitivity studies were conducted to assess the effects of different doses and individual opioids. RESULTS Of 9823 eligible mothers, 545 (5.5%) filled one or more prescription opioid during pregnancy. Compared with those unexposed, no significant risk was observed in primary analyses, while in secondary analyses opioid-exposed mothers were associated with an increased risk of cesarean antepartum depression (HR 3.19; 95% CI 1.22-8.33), and cardiac events (HR 9.44; 95% CI 1.19-74.83). In sensitivity analyses, results are more prominent in high dose exposure and are consistent for individual opioids. CONCLUSIONS Prescription opioid use during pregnancy is associated with an increased risk of maternal complications.
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Affiliation(s)
- Xuerong Wen
- Health Outcomes, Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA.
| | - Shuang Wang
- Health Outcomes, Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristina E Ward
- Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Erin Christine Brousseau
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kimford J Meador
- Department of Neurology, Stanford University, Palo Alto, CA, USA
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Wen X, Lawal OD, Belviso N, Matson KL, Wang S, Quilliam BJ, Meador KJ. Association Between Prenatal Opioid Exposure and Neurodevelopmental Outcomes in Early Childhood: A Retrospective Cohort Study. Drug Saf 2021; 44:863-875. [PMID: 34100263 DOI: 10.1007/s40264-021-01080-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Several studies have reported increasing prevalence of prescription opioid use among pregnant women. However, little is known regarding the effects of maternal opioid use on neurodevelopmental disorders in early childhood in pregnant women with no evidence of opioid use disorders or drug dependence. OBJECTIVE The aim of this study was to quantify the association between prenatal opioid exposure from maternal prescription use and neurodevelopmental outcomes in early childhood. METHODS This retrospective study included pregnant women aged 12-55 years and their live-birth infants born from 2010 to 2012 present in Optum's deidentified Clinformatics® Data Mart database. Eligible infants born to mothers without opioid use disorders or drug dependence were followed till occurrence of neurodevelopmental disorders, loss to follow-up, or study end (December 31, 2017), whichever came first. Propensity score by fine stratification was applied to adjust for confounding by demographic characteristics, obstetric characteristics, maternal comorbid mental and pain conditions, and measures of burden of illnesses and to obtain adjusted hazard ratios (HR) and 95% confidence intervals (CI). Exposed and unexposed infants were compared on the incidence of neurodevelopmental disorders. RESULTS Of 24,910 newborns, 7.6% (1899) were prenatally exposed to prescription opioids. Overall, 1562 children were diagnosed with neurodevelopmental disorders, with crude incidence rates of 2.9 per 100 person-years in exposed children versus 2.5 per 100 person-years in unexposed children. After adjustment, we observed no association between fetal opioid exposure and the risk of neurodevelopmental disorders (HR 1.10; 95% CI 0.92-1.32). However, increased risk of neurodevelopmental disorders were observed in children with longer cumulative exposure duration (HR 1.70; 95% CI 1.05-2.96) or high cumulative opioid doses (HR 1.22; 95% CI 1.01-1.54). CONCLUSION AND RELEVANCE In pregnant women without opioid use disorders or drug dependence, maternal opioid use was not associated with increased risk of neurodevelopmental disorders in early childhood. However, increased risks of early neurodevelopmental disorders were observed in children born to women receiving prescription opioids for longer duration and at higher doses during pregnancy.
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Affiliation(s)
- Xuerong Wen
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA.
| | - Oluwadolapo D Lawal
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Nicholas Belviso
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Kelly L Matson
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Shuang Wang
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Suite 265F, Kingston, RI, 02881, USA
| | - Brian J Quilliam
- College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, California, CA, USA
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Corsi DJ, Murphy MSQ. The Effects of opioids on female fertility, pregnancy and the breastfeeding mother-infant dyad: A Review. Basic Clin Pharmacol Toxicol 2021; 128:635-641. [PMID: 33650271 DOI: 10.1111/bcpt.13577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
Opioids cover a broad class of natural, synthetic and semi-synthetic drugs that act on opioid receptors to produce powerful analgesic effects. Rates of opioid use and opioid agonist maintenance treatment have increased substantially in recent years, particularly among women. Trends and outcomes of opioids use on fertility, pregnancy and breastfeeding, and longer-term child developmental outcomes have not been well-described. Here, we review the existing literature on the health effects of opioid use on female fertility, pregnancy, breastmilk and the exposed infant. We find that the current literature is primarily concentrated on the impact of opioid use in pregnancy and neonatal outcomes, with little exploration of effects on fertility. Studies are limited in number, some with small sample sizes, and many are hampered by methodological challenges related to confounding and other potential biases. Opioid use is becoming more prevalent due to environmental pressures such as COVID-19. More research is needed to better elucidate its effects on reproductive health among younger women and support the development of evidence-based recommendations for safe prescription practices and public health messaging.
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Affiliation(s)
- Daniel J Corsi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Malia S Q Murphy
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Trepman P, Villars M, Chang YT, Rosen Z. The Association Between Health Insurance and Opioid Misuse in Pregnancy. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2020. [DOI: 10.29024/jsim.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Nguyen NH, Le EN, Mbah VO, Welsh EB, Daas R, Spooner KK, Salemi JL, Olaleye OA, Salihu HM. Opioid Use Among HIV-Positive Pregnant Women and the Risk for Maternal-Fetal Complications. South Med J 2020; 113:292-297. [PMID: 32483639 DOI: 10.14423/smj.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess patient- and hospital-level characteristics associated with opioid use in human immunodeficiency virus (HIV)-positive pregnant women and fetal health outcomes. METHODS Using the 2002-2014 Nationwide Inpatient Sample database, we analyzed discharge records to describe the rates of opioid use among HIV-positive pregnant women. Logistic regression was used to quantify the magnitude of the association between exposure status and maternal-fetal outcomes. RESULTS Opioid use was fourfold greater among HIV-positive pregnant women compared with their HIV-negative counterparts (odds ratio 4.0; 95% confidence interval 3.15-5.12). Relatively smaller but significant increases in the early onset of delivery, poor fetal growth, abortive pregnancy, and spontaneous abortion also were observed in association with HIV-positive status and opioid drug use during pregnancy. CONCLUSIONS An increased risk of negative maternal-fetal complications persists among HIV-positive women who use opioids during pregnancy. Focusing on predisposing factors and monitoring opioid dispensing may mitigate overuse or abuse in this vulnerable population.
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Affiliation(s)
- Ngoc H Nguyen
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Erika N Le
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Vanessa O Mbah
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Emily B Welsh
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Rana Daas
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Kiara K Spooner
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jason L Salemi
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Omonike A Olaleye
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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12
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Salemi JL, Raza SA, Modak S, Fields-Gilmore JAR, Mejia de Grubb MC, Zoorob RJ. The association between use of opiates, cocaine, and amphetamines during pregnancy and maternal postpartum readmission in the United States: A retrospective analysis of the Nationwide Readmissions Database. Drug Alcohol Depend 2020; 210:107963. [PMID: 32278846 DOI: 10.1016/j.drugalcdep.2020.107963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Substance use during pregnancy has increased in the United States, with adverse consequences for mother and baby. Similarly, postpartum readmission (PPR) imposes physical, emotional, and financial stressors causing disruption to family functioning and childcare. We used national data to estimate the extent to which women who used opiates, cocaine, and amphetamines during pregnancy are at increased risk of PPR. METHODS We analyzed 2010-2014 data from the Nationwide Readmissions Database (NRD). Our exposure, drug use during pregnancy, was identified using diagnosis codes indicative of opioid, cocaine or amphetamine use, abuse, or dependence. The outcome was all-cause PPR, maternal readmission within 42 days following discharge from the delivery hospitalization. Multivariable logistic regression was used to estimate odds ratios (OR) that represented associations between drug use and PPR. RESULTS Among 11 million delivery hospitalizations, nearly 1 % had documented use of opiates, cocaine and/or amphetamines. The crude PPR rate was nearly four times higher among users (54.6 per 1000) compared to non-users (14.0 per 1000), and 1 in 10 women who had documented use of more than one drug category experienced postpartum readmission. Even after controlling for sociodemographic and clinical confounders, we observed a two-fold increased odds of PPR among users compared to non-users (OR = 1.95; 95 % CI: 1.82, 2.07). CONCLUSIONS The national opioid epidemic should encourage a paradigm shift in health care public policy to facilitate the management of all substance use disorders as chronic medical conditions through evidence-based public health initiatives to prevent these disorders, treat them, and promote recovery.
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Affiliation(s)
- Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, United States; Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - Syed Ahsan Raza
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sanjukta Modak
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Jo Anna R Fields-Gilmore
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Maria C Mejia de Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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Roeder HJ, Lopez JR, Miller EC. Ischemic stroke and cerebral venous sinus thrombosis in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:3-31. [PMID: 32768092 PMCID: PMC7528571 DOI: 10.1016/b978-0-444-64240-0.00001-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal ischemic stroke and cerebral venous sinus thrombosis (CVST) are dreaded complications of pregnancy and major contributors to maternal disability and mortality. This chapter summarizes the incidence and risk factors for maternal arterial ischemic stroke (AIS) and CVST and discusses the pathophysiology of maternal AIS and CVST. The diagnosis, treatment, and secondary preventive strategies for maternal stroke are also reviewed. Special populations at high risk of maternal stroke, including women with moyamoya disease, sickle cell disease, HIV, thrombophilia, and genetic cerebrovascular disorders, are highlighted.
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Affiliation(s)
- Hannah J Roeder
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Jean Rodriguez Lopez
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Eliza C Miller
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States.
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14
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Edelson PK, Bernstein SN. Management of the Cardiovascular Complications of Substance Use Disorders During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:73. [PMID: 31754867 DOI: 10.1007/s11936-019-0777-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Substance use disorder in pregnancy and subsequent cardiovascular complications are on the rise in the USA. The care of pregnant women with substance use disorder is complex, and requires a thorough understanding of mechanisms of action, pathophysiology, and cardiovascular response during pregnancy. The goal of this review is to provide information about the most common drugs of abuse in pregnancy and to recommend management guidelines. RECENT FINDINGS Pregnant women with substance use disorder are at increased risk of significant cardiovascular complications, both as a direct effect of acute intoxication as well as the secondary risk from infection and cardiotoxicity associated with chronic use. This risk must be considered in the antepartum management, delivery, and postpartum periods. Understanding the increased cardiovascular risk of pregnant women with substance use disorder, as well as specific drug interactions, anesthesia considerations, best practices, and management considerations, is important for all clinicians caring for this population.
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Affiliation(s)
- P Kaitlyn Edelson
- Department of Obstetrics and Gynecology Founders 4, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Sarah N Bernstein
- Department of Obstetrics and Gynecology Founders 4, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care. Obstet Gynecol 2019; 133:289-300. [PMID: 30633134 DOI: 10.1097/aog.0000000000003062] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment. METHODS Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status. Modeled outcomes included hepatitis C diagnosis, treatment and cure, lifetime health care costs, quality-adjusted life years (QALY) and incremental cost-effectiveness ratios comparing universal prenatal hepatitis C screening to current practice. We modeled whether neonates exposed to maternal HCV at birth were identified as such. RESULTS Pregnant women with hepatitis C infection lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an incremental cost-effectiveness ratio of $41,000 per QALY gained compared with current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included incremental cost-effectiveness ratios above $100,000 when assuming mean time to cirrhosis of 70 years, a cost greater than $500,000 per false positive diagnosis, or population HCV infection prevalence below 0.16%. Universal prenatal hepatitis C screening increased identification of neonates exposed to HCV at birth from 44% to 92%. CONCLUSIONS In our model, universal prenatal hepatitis C screening improves health outcomes in women with HCV infection, improves identification of HCV exposure in neonates born at risk, and is cost-effective.
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Ogungbe O, Akil L, Ahmad HA. Exploring Unconventional Risk-Factors for Cardiovascular Diseases: Has Opioid Therapy Been Overlooked? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142564. [PMID: 31323774 PMCID: PMC6678387 DOI: 10.3390/ijerph16142564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022]
Abstract
Approximately 2150 adults die every day in the U.S. from Cardiovascular Diseases (CVD) and another 115 deaths are attributed to opioid-related causes. Studies have found conflicting results on the relationship between opioid therapy and the development of cardiovascular diseases. This study examined whether an association exists between the use of prescription opioid medicines and cardiovascular diseases, using secondary data from the National Hospital Ambulatory Medical Care Survey (NAMCS) 2015 survey. Of the 1829 patients, 1147 (63%) were male, 1762 (98%) above 45 years of age, and 54% were overweight. The rate of cardiovascular diseases was higher among women [(p < 0.001), 95% CI: 0.40–0.51]. The covariates were age, race/ethnicity, sex, diabetes mellitus, hyperlipidemia, and hypertension; and were adjusted. Diabetes mellitus, hyperlipidemia, and hypertension were significant predictors of CVD [(p < 0.001, 95% CI: 0.57–0.78); (p < 0.001, 95% CI: 0.34–0.44); (p < 0.001, 95% CI: 0.49–0.59)]. There was no significant association between prescription opioid medication use and coronary artery disease [first opioid group p = 0.34, Prevalence Odds Ratio (POR): 1.39, 95% CI: 0.71–2.75; second opioid group: p = 0.59, POR: 1.20, 95% CI: 0.61–2.37, and third opioid group: p = 0.62, POR: 0.85, 95% CI: 0.45–1.6]. The results of this study further accentuate the conflicting results in literature. Further research is recommended, with a focus on those geographical areas where high prevalence of cardiovascular diseases exists.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Luma Akil
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Hafiz A Ahmad
- Department of Biology, Jackson state University, Jackson, MS 39217, USA.
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Mejia de Grubb MC, Salemi JL, Gonzalez SJ, Chima CC, Kowalchuk AA, Zoorob RJ. Opioid, cocaine, and amphetamine use disorders are associated with higher30-day inpatient readmission rates in the United States. Subst Abus 2019; 41:365-374. [PMID: 31295052 DOI: 10.1080/08897077.2019.1635964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Patients with substance use disorders (SUDs) are more likely to experience serious health problems, high healthcare utilization, and premature death. However, little is known about the contribution of SUDs to medical 30-day readmission risk. We examined the association between SUDs and 30-day all cause readmission among non-pregnant adult in-patients in the US. Methods: We conducted a retrospective study using 2010-2014 data from the Nationwide Readmissions Database. Our primary focus was on opioid use compared to stimulant use (cocaine and amphetamine) identified by ICD-9-CM diagnosis codes in index hospitalizations. Multivariable logistic regression models were used to estimate adjusted odds ratios and 95% CI representing the association between substance use and 30-day readmission, overall and stratified by the principal reason for the index hospitalization. Results: Nearly 118 million index hospitalizations were included in the study, 4% were associated with opioid or stimulant use disorder. Readmission rates for users (19.5%) were higher than for nonusers (15.7%), with slight variation by the type of substance used: cocaine (21.8%), opioid (19.0%), and amphetamine (17.5%). After adjusting for key demographic, socioeconomic, clinical, and health system characteristics, SUDs and stimulant use disorders increased the odds of 30-day all-cause readmission by 20%. Conclusions: Reducing the frequency of inpatient readmission is an important goal for improving the quality of care and ensuring proper transition to residential/outpatient care among patients with SUDs. Differences between groups may suggest directions for further investigation into the distinct needs and challenges of hospitalized opioid- and other drug-exposed patients.
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Affiliation(s)
- Maria C Mejia de Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Charles C Chima
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alicia A Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
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Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int J Mol Sci 2019; 20:ijms20030584. [PMID: 30700023 PMCID: PMC6387265 DOI: 10.3390/ijms20030584] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 01/19/2023] Open
Abstract
Cardiac complications resulting from cocaine use have been extensively studied because of the complicated pathophysiological mechanisms. This study aims to review the underlying cellular and molecular mechanisms of acute and chronic effects of cocaine on the cardiovascular system with a specific focus on human studies. Studies have consistently reported the acute effects of cocaine on the heart (e.g., electrocardiographic abnormalities, acute hypertension, arrhythmia, and acute myocardial infarction) through multifactorial mechanisms. However, variable results have been reported for the chronic effects of cocaine. Some studies found no association of cocaine use with coronary artery disease (CAD), while others reported its association with subclinical coronary atherosclerosis. These inconsistent findings might be due to the heterogeneity of study subjects with regard to cardiac risk. After cocaine use, populations at high risk for CAD experienced coronary atherosclerosis whereas those at low risk did not experience CAD, suggesting that the chronic effects of cocaine were more likely to be prominent among individuals with higher CAD risk. Studies also suggested that risky behaviors and cardiovascular risks may affect the association between cocaine use and mortality. Our study findings highlight the need for education regarding the deleterious effects of cocaine, and access to interventions for cocaine abusers.
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Affiliation(s)
- Sung Tae Kim
- Department of Pharmaceutical Engineering, Inje University, Gimhae 50834, Korea.
| | - Taehwan Park
- Pharmacy Administration, St. Louis College of Pharmacy, St. Louis, MO 63110, USA.
- Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO 63110, USA.
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