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Huang RS, Spence AR, Abenhaim HA. Non-Obstetric Maternal Mortality Trends by Race in the United States. Matern Child Health J 2024; 28:895-904. [PMID: 38147278 DOI: 10.1007/s10995-023-03862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US). METHODS A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90-2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13-1.17) and American Indian women (1.17, 1.13-1.21). CONCLUSION Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes.
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Affiliation(s)
- Ryan S Huang
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Andrea R Spence
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 5790 Cote-Des Neiges, Pav. H 325, Montreal, QC, H3S 1Y9, Canada.
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Hill AL, Keil MA, Chang JC, Krans EE, Kim E, Nostrand EV, Miller E, Pallatino C. Help-Seeking Among Pregnant and Postpartum Women With Lifetime Experiences of Opioid Use Disorder and Intimate Partner Violence. Violence Against Women 2024; 30:812-831. [PMID: 36437759 DOI: 10.1177/10778012221140134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
We performed content analysis using a qualitative descriptive approach of 15 semistructured interviews with pregnant and postpartum women who have experienced opioid use disorder (OUD) and intimate partner violence (IPV) regarding their experiences seeking help with both issues. Participants described that their partners impacted their ability to seek OUD care; seeking help for OUD and IPV was siloed; they felt more comfortable disclosing OUD than IPV; they perceived pregnancy as a barrier and facilitator to OUD care; and they wished for integrated services. Pregnant and postpartum women experiencing OUD and IPV acknowledged these phenomena intersect and identified a need for more comprehensive services.
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Affiliation(s)
| | | | - Judy C Chang
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Elizabeth E Krans
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Esther Kim
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bass R, Flinchum G, Ramage M, Galvin SL, Cabello-De la Garza A, Caron O, Marietta A. Accessing perinatal substance use disorder care in your local community: A case study of an innovative hub and spoke network in western North Carolina. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209268. [PMID: 38097044 DOI: 10.1016/j.josat.2023.209268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION The incidence of substance use disorders (SUD) in the general population and in the pregnant person population has risen over the last 20 years. Concurrently, both perinatal and SUD care in rural areas is laden with access barriers including but not limited to geographical distance from potential treatment and stigma. An integrated outpatient perinatal substance use disorder (PSUD) clinic in an urban area in western North Carolina (WNC) found that patients who traveled further for prenatal care were less likely to continue seeking care in the postpartum period. Acknowledging that the risk of overdose increases in the postpartum period, the PSUD clinic utilized a hub and spoke model to promote healthcare accessibility. METHODS The clinic adapted the Vermont hub and spoke model and the CHARM (Children and Recovering Mothers) collaborative. The urban hub in WNC has now developed eight spokes in rural communities. The hub provides education and technical assistance to the rural spokes, and the two engage in bidirectional referral pathways. This manuscript details the model and analyzes the existing strengths and barriers at two spokes, a family medicine Federally Qualified Health Center and a hospital affiliated obstetrics and gynecology practice and analyzes their process of implementation of integrated outpatient perinatal substance use care. RESULTS Both spokes found coaching relationships and the sharing of resources such as clinical guidelines useful to begin prescribing buprenorphine for PSUD. Their context led one spoke to begin prescribing within one year while the other took two years. CONCLUSION Comparing and contrasting these spokes serves to demonstrate that across many contexts, a hub and spoke model is a replicable intervention for rural perinatal substance use access to care barriers. Comparing the two spokes emphasizes the need for adaptation as well as standardization of the model to improve evidence-based PSUD care most effectively.
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Affiliation(s)
- Rebekah Bass
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA.
| | - Grace Flinchum
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA
| | - Melinda Ramage
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA
| | - Shelley L Galvin
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA
| | - Ana Cabello-De la Garza
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA
| | - Olivia Caron
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA; Department of Pharmacotherapy at Mountain Area Health Education Center (MAHEC), 125 Hendersonville Road, Asheville, NC 28803, USA; UNC-Chapel Hill Eshelman School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599, USA
| | - Amy Marietta
- Department of OB/GYN Project CARA at Mountain Area Health Education Center (MAHEC), 119 Hendersonville Road, Asheville, NC 28803, USA
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443b: Opioid Use Throughout Women's Lifespan: Opioid Use in Pregnancy and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102144. [PMID: 37977721 DOI: 10.1016/j.jogc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers the best evidence on opioid use and women's health. Areas of focus include pregnancy and postpartum care. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will improve patient care. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Opioid use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Health care providers need to understand the effect opioids can have on pregnant women and support them to make knowledgeable decisions about their health. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome, and breastfeeding. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care providers who care for pregnant and/or post-partum women and their newborns. TWEETABLE ABSTRACT Opioid use during pregnancy often co-occurs with mental health issues and is associated with adverse maternal, fetal, and neonatal outcomes; treatment of opioid use disorder with agonist therapy for pregnant women can be safe during pregnancy where the risks outnumber the benefits. SUMMARY STATEMENTS RECOMMENDATIONS.
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443b : Opioïdes aux différentes étapes de la vie des femmes : Grossesse et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102146. [PMID: 37977719 DOI: 10.1016/j.jogc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIF Présenter aux professionnels de la santé les données probantes concernant l'utilisation des opioïdes et la santé des femmes. Les domaines d'intérêt sont la grossesse et les soins post-partum. POPULATION CIBLE Toutes les femmes qui utilisent des opioïdes. RéSULTATS: Un dialogue ouvert et éclairé sur l'utilisation des opioïdes améliorera les soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation d'opioïdes par une approche tenant compte des traumatismes antérieurs donne au professionnel de la santé et à la patiente l'occasion de bâtir une alliance solide, collaborative et thérapeutique. Cette alliance permet aux femmes de faire des choix éclairés. Elle favorise le diagnostic et le traitement possible du trouble lié à l'utilisation d'opioïdes. L'utilisation ne doit pas être stigmatisée, puisque la stigmatisation affaiblit le partenariat (le partenariat entre patiente et professionnel de la santé). Les professionnels de la santé ceus-ci doivent comprendre l'effet potentiel des opioïdes sur la santé les femmes enceintes et les aider à prendre des décisions éclairées sur leur santé. DONNéES PROBANTES: Une recherche a été conçue puis effectuée dans les bases de données PubMed et Cochrane Library pour la période d'août 2018 à mars 2023 des termes MeSH et mots clés suivants (et variantes) : opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome et breastfeeding. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les professionnels de la santé qui prodiguent des soins aux femmes et aux nouveaux-nés. RéSUMé POUR TWITTER: La consommation d'opioïdes pendant la grossesse coïncide souvent avec des problèmes de santé mentale et est associée à des conséquences néfastes pour la mère, le fœtus et le nouveau-né ; le traitement des troubles liés à la consommation d'opioïdes par agonistes peut être sûr pendant la grossesse lorsque les risques sont plus nombreux que les avantages. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Barber CM, Terplan M. Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective. Front Pediatr 2023; 11:1045745. [PMID: 37292372 PMCID: PMC10246753 DOI: 10.3389/fped.2023.1045745] [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: 09/16/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.
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Affiliation(s)
- Cecily May Barber
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
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Ellis LP, Parlier-Ahmad AB, Scheikl M, Martin CE. An Integrated Care Model for Pregnant and Postpartum Individuals Receiving Medication for Opioid Use Disorder. J Addict Med 2023; 17:131-139. [PMID: 35972153 PMCID: PMC9931937 DOI: 10.1097/adm.0000000000001052] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Perinatal opioid use disorder is increasing. Integrated obstetric/addiction care models likely optimize parent-infant dyad outcomes, but the ideal combination of services is unknown. This study (1) describes pregnancy-to-postpartum service utilization by people receiving buprenorphine at an integrated Obstetric/Addiction Clinic and (2) explores the association between service utilization and postpartum buprenorphine continuation. METHODS This retrospective medical record review study uses research registry data from an outpatient Obstetric/Addiction Clinic. All patients are invited to participate in the research registry. For patients who consent, monthly medical record abstractions are conducted beginning with their first clinic visit to collect demographic, obstetric, and substance use disorder treatment variables. Present analyses included patients who delivered an infant between June 2019 and June 2021, started buprenorphine during pregnancy, and were receiving buprenorphine at delivery. Overall service utilization was the number of services (range 0-12) used between 28-weeks gestation and 12-weeks postpartum. Bivariate analyses and multivariable logistic regression assessed associations between service utilization and buprenorphine continuation. RESULTS Participants (n = 42) were primarily non-Latinx White (67%) with comorbid psychiatric diagnoses (95%). On average, participants used 6 services; prenatal care, mental health care, and postpartum contraception were most utilized. Overall, 69% of participants continued buprenorphine at 6 months postpartum. This did not differ by level of service utilization (bivariate [ P = 0.07], multivariable [ P = 0.16]). CONCLUSION Integrated care with a harm reduction focus supports pregnancy-to-postpartum service utilization and buprenorphine continuation in a patient sample at high risk for medication for opioid use disorder discontinuation. Further work is needed to identify evidence-based methods to individualize integrated obstetric/addiction care.
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Affiliation(s)
| | - Anna Beth Parlier-Ahmad
- Department of Psychology, Virginia Commonwealth University, 401 N. 11th Street, Richmond, VA 23219, USA
| | - Marjorie Scheikl
- Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
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Lim G, Soens M, Wanaselja A, Chyan A, Carvalho B, Landau R, George RB, Klem ML, Osmundson SS, Krans EE, Terplan M, Bateman BT. A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine. Anesth Analg 2022; 135:912-925. [PMID: 36135926 PMCID: PMC9588509 DOI: 10.1213/ane.0000000000006167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevalence of pregnant people with opioid use disorder (OUD), including those receiving medications for opioid use disorder (MOUD), is increasing. Challenges associated with pain management in people with OUD include tolerance, opioid-induced hyperalgesia, and risk for return to use. Yet, there are few evidence-based recommendations for pain management in the setting of pregnancy and the postpartum period, and many peripartum pain management studies exclude people with OUD. This scoping review summarized the available literature on peridelivery pain management in people with OUD, methodologies used, and identified specific areas of knowledge gaps. PubMed and Embase were comprehensively searched for publications in all languages on peripartum pain management among people with OUD, both treated with MOUD and untreated. Potential articles were screened by title, abstract, and full text. Data abstracted were descriptively analyzed to map available evidence and identify areas of limited or no evidence. A total of 994 publications were imported for screening on title, abstracts, and full text, yielding 84 publications identified for full review: 32 (38.1%) review articles, 14 (16.7%) retrospective studies, and 8 (9.5%) case reports. There were 5 randomized controlled trials. Most studies (64%) were published in perinatology (32; 38.1%) journals or anesthesiology (22; 26.2%) journals. Specific areas lacking trial or systematic review evidence include: (1) methods to optimize psychological and psychosocial comorbidities relevant to acute pain management around delivery; (2) alternative nonopioid and nonpharmacologic analgesia methods; (3) whether or not to use opioids for severe breakthrough pain and how best to prescribe and monitor its use after discharge; (4) monitoring for respiratory depression and sedation with coadministration of other analgesics; (5) optimal neuraxial analgesia dosing and adjuncts; and (6) benefits of abdominal wall blocks after cesarean delivery. No publications discussed naloxone coprescribing in the labor and delivery setting. We observed an increasing number of publications on peripartum pain management in pregnant people with OUD. However, existing published works are low on the pyramid of evidence (reviews, opinions, and retrospective studies), with a paucity of original research articles (<6%). Opinions are conflicting on the utility and disutility of various analgesic interventions. Studies generating high-quality evidence on this topic are needed to inform care for pregnant people with OUD. Specific research areas are identified, including utility and disutility of short-term opioid use for postpartum pain management, role of continuous wound infiltration and truncal nerve blocks, nonpharmacologic analgesia options, and the best methods to support psychosocial aspects of pain management.
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Affiliation(s)
- Grace Lim
- University of Pittsburgh Department of Anesthesiology & Perioperative Medicine, Pittsburgh, PA
- University of Pittsburgh Department of Obstetrics & Gynecology, UPMC Magee-Women’s Hospital, Pittsburgh, PA
| | - Mieke Soens
- Brigham & Women’s Hospital, Department of Anesthesiology & Perioperative Medicine, Boston, MA
| | - Anne Wanaselja
- University of Pittsburgh Department of Anesthesiology & Perioperative Medicine, Pittsburgh, PA
| | - Arthur Chyan
- Brigham & Women’s Hospital, Department of Anesthesiology & Perioperative Medicine, Boston, MA
| | - Brendan Carvalho
- Stanford University Department of Anesthesiology, Perioperative & Pain Medicine, Palo Alto, CA
| | - Ruth Landau
- Columbia University Department of Anesthesiology & Perioperative Medicine, New York City, NY
| | - Ronald B. George
- University of California San Francisco Department of Anesthesiology & Perioperative Care, San Francisco, CA
| | - Mary Lou Klem
- University of Pittsburgh Health Sciences Library System, Pittsburgh, PA
| | - Sarah S. Osmundson
- Vanderbilt University, Department of Obstetrics & Gynecology, Nashville, TN
| | - Elizabeth E. Krans
- University of Pittsburgh Department of Obstetrics & Gynecology, UPMC Magee-Women’s Hospital, Pittsburgh, PA
| | | | - Brian T. Bateman
- Stanford University Department of Anesthesiology, Perioperative & Pain Medicine, Palo Alto, CA
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Cleary EM, Smid MC, Bokat C, Costantine MM, Rood KM. Indicated Opioids in Pregnancy: Guidance on Providing Comprehensive Care. Am J Perinatol 2021; 40:602-611. [PMID: 34768306 DOI: 10.1055/s-0041-1739427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In modern obstetric practice, providers will encounter patients for whom opioid use in pregnancy is reasonable or even necessary. A "one-size-fits-all" approach to the counseling and management of such patients is misguided. Understanding indications for ongoing opioid use in pregnancy is essential to patient-centered care. Specifically, recognition of the nuanced differences between opioid dependence and opioid use disorder is crucial for appropriate diagnosis, screening for common concurrent conditions, adequately counseling about individualized maternal and perinatal risks, and accurate documentation of diagnoses and medical decision-making. In this paper, we explore the current typical scenarios in which opioid use in pregnancy may be encountered, ongoing opioid prescribing should be considered, and provide a guide for the obstetric provider to navigate the antepartum, intrapartum, and postpartum periods. KEY POINTS: · Opioid use in pregnant and postpartum individuals is not rare.. · Obstetric providers may elect to assume opioid prescribing.. · Obstetric providers are positioned to optimize outcomes for the mother-infant dyad..
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Affiliation(s)
- Erin M Cleary
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Christina Bokat
- Department of Anesthesia, University of Utah Health, Salt Lake City, Utah
| | - Maged M Costantine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara M Rood
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Martin CE, Parlier-Ahmad AB. Addiction treatment in the postpartum period: an opportunity for evidence-based personalized medicine. Int Rev Psychiatry 2021; 33:579-590. [PMID: 34238101 PMCID: PMC8490333 DOI: 10.1080/09540261.2021.1898349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Substance use disorders (SUD) are becoming rapidly more prevalent in women and a leading cause of pregnancy associated deaths, with most deaths occurring during the 12 months after pregnancy. The postpartum period can be quite intense, especially for women seeking addiction recovery. There is a call to reconceptualize the obstetrical postpartum care model into one that extends specialised care and is tailored to an individual's specific needs. Although SUD treatment improves maternal and infant outcomes as well as decreases overdose risk, many women do not receive consistent SUD treatment during the postpartum period. Thus, SUD treatments should consider following the same guidance as obstetrics to reconceptualize how SUD treatment is delivered postpartum. Clinically, this translates into substantially modifying traditional siloed SUD treatment structures to meet the unique needs of this vulnerable patient population. At the same time, more research is urgently needed to inform these advancements in clinical care to ensure they are evidence-based and effective. In this article, we review the existing evidence as well as highlight opportunities for both clinicians and researchers to advance the integration of tailored approaches for postpartum women into personalised SUD medical and behavioural treatments.
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Affiliation(s)
- Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
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Cleary EM, Smid MC, Charles JE, Jones KM, Costantine MM, Saade G, Rood KM. Buprenorphine X-waiver exemption - beyond the basics for the obstetrical provider. Am J Obstet Gynecol MFM 2021; 3:100451. [PMID: 34320429 DOI: 10.1016/j.ajogmf.2021.100451] [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: 07/04/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Buprenorphine is 1 of 3 medications approved by the US Food and Drug Administration for the treatment of opioid use disorder, and practitioners must obtain a federal waiver to prescribe buprenorphine. Until recently, physicians and advanced practice clinicians were required to complete 8 and 24 hours of training, respectively, before applying for this waiver and to provide psychosocial services when prescribing buprenorphine to ≤30 patients. The US Department of Health and Human Services announced in April 2021 that eligible providers would be exempt from the educational requirement for certification, making the waiver more accessible for those intending to prescribe to ≤30 patients. Here, we reviewed the historic background to the exemption and provided practical guidelines to practitioners caring for obstetrical patients with opioid use disorder who are considering applying for the waiver for the first time. Because the educational requirements will no longer be required for X-waiver application, we reviewed fundamental topics and challenging scenarios that are often reviewed in certification courses.
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Affiliation(s)
- Erin M Cleary
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
| | - Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | - Jasmin E Charles
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | - Kaitlyn M Jones
- College of Nursing, University of Utah Health, Salt Lake City, UT
| | - Maged M Costantine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - George Saade
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Kara M Rood
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
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Shadowen C, Moeller FG, Martin CE. The Use of Once-monthly Injectable Buprenorphine for the Treatment of Opioid Use Disorder in Postpartum Women: A Case Series. J Addict Med 2021; 15:292-296. [PMID: 34397780 PMCID: PMC8369037 DOI: 10.1097/adm.0000000000000835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For women with opioid use disorder (OUD), the postpartum period is an especially vulnerable period. Buprenorphine (BUP) improves OUD outcomes during this timeframe. Once-monthly injectable BUP (XRI-BUP) is a newer formulation for which evidence of use in postpartum women is extremely limited. We present a case series of 9 women who transitioned from sublingual (SL-BUP) to XRI-BUP in their first year postpartum. METHODS We conducted a retrospective chart review of our institution's medical record for patients who received at least one administration of XRI-BUP in their first year postpartum (January 2017-March 2020). Data were collected from baseline through mean follow-up of 281.4 days (range 235-417) for participant outcomes. RESULTS The most common indications for initiating XRI-BUP were participant preference (n = 9) followed by challenges taking SL-BUP (n = 6). Four of the 9 participants transitioned back from XRI- to SL-BUP during the study timeframe, for reasons including incarceration and undesired side effects. Preliminary treatment outcomes demonstrated that participants remained on SL- (n = 4) or XRI-BUP (n = 5) through follow-up. The 5 participants who remained on XRI-BUP had consistent negative urine drug tests for nonprescribed opioids during the study period. CONCLUSIONS To our knowledge, this is the first study that reviews the feasibility of using XRI-BUP in postpartum women. Our results suggest that XRI-BUP is a viable treatment option, which should be further investigated in future studies of postpartum women with OUD.
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Affiliation(s)
| | - F. Gerard Moeller
- Virginia Commonwealth University School of Medicine
- Department of Psychiatry
- Institute for Drug and Alcohol Studies
| | - Caitlin E. Martin
- Virginia Commonwealth University School of Medicine
- Institute for Drug and Alcohol Studies
- Department of Obstetrics and Gynecology
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Campbell J, Matoff-Stepp S, Velez ML, Cox HH, Laughon K. Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence. J Womens Health (Larchmt) 2021; 30:236-244. [PMID: 33295844 PMCID: PMC8020563 DOI: 10.1089/jwh.2020.8875] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The leading causes of pregnancy-associated deaths, as defined by the Centers for Disease Control and Prevention, are homicide, suicide, and drug overdose. Intimate partner violence during pregnancy has been shown to contribute to maternal mortality from pregnancy-associated deaths. In this article, we discuss these leading causes of pregnancy-associated deaths. We review the prevalence, demographic characteristics, and possible factors leading to each cause of death, as well as evidence-based methods of identification, prevention, and intervention. The review also will include data showing racial and ethnic inequities. In addition, we identify gaps and guiding questions for further research, as well as suggestions for immediate changes in practice and policy.
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Affiliation(s)
| | - Sabrina Matoff-Stepp
- Office of Planning, Analysis, and Evaluation, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Martha L. Velez
- Center for Addiction and Pregnancy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen Hunter Cox
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn Laughon
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, Virginia, USA
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