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Heller NA, Logan BA, Shrestha H, Morrison DG, Hayes MJ. Effect of Neonatal Abstinence Syndrome Treatment Status and Maternal Depressive Symptomatology on Maternal Reports of Infant Behaviors. J Pediatr Psychol 2023; 48:583-592. [PMID: 37159522 PMCID: PMC10321377 DOI: 10.1093/jpepsy/jsad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate the effects of maternal perinatal depression symptoms and infant treatment status for neonatal abstinence syndrome (NAS) on maternal perceptions of infant regulatory behavior at 6 weeks of age. METHODS Mothers and their infants (N = 106; 53 dyads) were recruited from a rural, White cohort in Northeast Maine. Mothers in medication-assisted treatment (methadone) and their infants (n = 35 dyads) were divided based on the infant's NAS pharmacological treatment (n = 20, NAS+ group; n = 15, NAS- group) and compared with a demographically similar, nonexposed comparison group (n = 18 dyads; COMP group). At 6 weeks postpartum, mothers reported their depression symptoms Beck Depression Inventory-2nd Edition) and infant regulatory behaviors [Mother and Baby Scales (MABS)]. Infant neurobehavior was assessed during the same visit using the Neonatal Network Neurobehavioral Scale (NNNS). RESULTS Mothers in the NAS+ group showed significantly higher depression scores than the COMP group (p < .05) while the NAS- group did not. Across the sample, mothers with higher depression scores reported higher infant "unsettled-irregularity" MABS scores, regardless of group status. Agreement between maternal reports of infant regulatory behaviors and observer-assessed NNNS summary scares was poor in both the NAS+ and COMP groups. CONCLUSIONS Postpartum women in opioid recovery with infants requiring pharmacological intervention for NAS are more at risk for depression which may adversely influence their perceptions of their infants' regulatory profiles. Unique, targeted attachment interventions may be needed for this population.
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Affiliation(s)
| | - Beth A Logan
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, USA
| | - Hira Shrestha
- Department of Medical Oncology, Dana-Farber Cancer Institute, USA
| | | | - Marie J Hayes
- Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, USA
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Isaacs KR, Atreyapurapu S, Alyusuf AH, Ledgerwood DM, Finnegan LP, Chang KHK, Ma TX, Washio Y. Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10215. [PMID: 34639512 PMCID: PMC8508043 DOI: 10.3390/ijerph181910215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. METHODS A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. RESULTS Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. CONCLUSIONS The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.
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Affiliation(s)
- Krystyna R. Isaacs
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Sravanthi Atreyapurapu
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Amal H. Alyusuf
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Drive, Detroit, MI 48201, USA;
| | - Loretta P. Finnegan
- Executive Officer of the College on Problems of Drug Dependence and Finnegan Consulting, Philadelphia, PA 19140, USA;
| | - Katie H. K. Chang
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Tony X. Ma
- Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA; (K.R.I.); (S.A.); (A.H.A.); (K.H.K.C.); (T.X.M.)
| | - Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, 3040 E Cornwallis Rd, Durham, NC 27709, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, 3500 N Broad St, Philadelphia, PA 19140, USA
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Cain SM, Conway A, Combs-Orme T, Bruck SL, Cook EK, Thomas E. Neonatal Abstinence Syndrome in Rural Appalachia. SOCIAL WORK 2021; 66:197-205. [PMID: 34143884 DOI: 10.1093/sw/swab014] [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: 12/05/2019] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 06/12/2023]
Abstract
As the United States faces the repercussions of the current opioid epidemic, it is important for social workers to be able to identify risks for poor birth outcomes in infants with neonatal abstinence syndrome (NAS). Although some studies have identified single risk factors, no studies have tested associations between total amount of risk (that is, cumulative risk) and birth outcomes in infants with NAS. Authors examined 318 mothers who used opioids during pregnancy and their infants' birthweight, length, head circumference, and Apgar scores (which measure overall infant health after birth). All infants were admitted to a neonatal intensive care unit in Appalachia and were diagnosed with NAS. Authors found that high cumulative risk during pregnancy was associated with lower birthweight and Apgar scores one and five minutes after birth as well as shorter length and smaller head circumference at birth. Social workers are encouraged to assess for the quantity of prenatal adversity experienced by the mothers they serve and to consider multicomponent, comprehensive community-based interventions to reduce cumulative risk.
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Affiliation(s)
- Shannon M Cain
- doctoral student and graduate research assistant, College of Social Work, University of Tennessee, Knoxville
| | - Anne Conway
- associate professor, College of Social Work, University of Tennessee, Knoxville
| | - Terri Combs-Orme
- professor emeritus, College of Social Work, University of Tennessee, Knoxville
| | - Sarah L Bruck
- outpatient therapist, Camelot Care Centers, Knoxville, TN
| | - E Kyle Cook
- neonatal nurse practitioner, Pediatrix Medical Group, East Tennessee Children's Hospital, Knoxville
| | - Elizabeth Thomas
- assistant professor, College of Social Work, University of Tennessee, Knoxville
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Brokatzky S. Patientin mit Schwangerschaft, Borderline-Organisation und schwerer Polytoxikomanie. SUCHTTHERAPIE 2021. [DOI: 10.1055/a-1441-6646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Zielsetzung Ziel dieser Arbeit war es, die Komplexität von Schwangerschaft und Sucht durch ein Fallbeispiel einer Patientin mit schwerer Polytoxikomanie, Borderline-Organisation sowie den Verlauf der Schwangerschaft und die frühe Phase nach der Geburt vorzustellen. Dabei ging es v. a. um die Frage, wie eine langfristige Behandlung mit einem mehrstufigen, multiprofessionellen und multimodalen Setting aussehen könnte. Die Arbeit zeigt zudem Konflikte an Schnittstellen auf und wie wichtig die Kommunikation innerhalb des Teams und fachübergreifend war.
Intervention Qualifizierte stationäre Entgiftungsbehandlung von Benzodiazepinen, Phenothiazin, Lyrica Venlafaxin und Reduktion von Methadon mit anschließender Umstellung auf Buprenorphin sowie ergänzender kombinierter ärztlicher, psychodynamischer Einzel- und Gruppentherapie und einem pflegerischen DBT-S Einzel- und Gruppensetting. Außerdem wurde schon während der Schwangerschaft zusätzlich zum stationären Behandlungsteam ein fächerübergreifendes Behandlungsteam aus Gynäkologen, Kinderärzten, Kinder- und Jugendpsychiatern sowie der Kinder- und Erwachsenenschutzbehörde (KESB, in Deutschland Jugendamt) zusammengestellt und schon zu Beginn wurde eine langfristige Behandlung mit stationärem, teilstationärem und ambulantem Intervall geplant.
Ergebnis Im Laufe der fast 3-jährigen Behandlung und 5 Jahre späteren katamnestischen Nachuntersuchung konnte zunächst unter 8 mg Buprenorphin eine Abstinenz von illegalen Substanzen erzielt werden. Im Verlauf sogar vollständige Abstinenz ohne Substitution. Dies konnte durch ein erneutes Interview und Drogenscreening im Jahr 2020 bestätigt werden. Außerdem konnte im Rahmen der fächerübergreifenden Arbeit ein stabiles soziales Umfeld und ein Wiedereinstieg ins Berufsleben erreicht werden.
Diskussion Trotz der anfänglich häufigen Rückfälle konnte durch den Erhalt der therapeutischen Beziehung (z. B. mittels Time-out auf die Akutstation, Verlängerung einer Wochenendbeurlaubung oder Neuverhandlung der Behandlungsvereinbarung) unter Fortsetzung der Einzelpsychotherapie und Bezugspflege mit Einbezug der Rückfälle, gegenseitiges Vertrauen und Wertschätzung geschaffen werden. Dafür war allerdings viel supervisorische Arbeit innerhalb des Teams, aber auch fächerübergreifend notwendig, da sich die extreme innerer Welt der Patientin häufig in unterschiedlicher Art und Weise im multiprofessionellen Team zeigte und dadurch zu Konflikten führte, die passager das Verlassen der Neutralität verlangten. Ferner waren für diese Art der Behandlung enorme Ressourcen notwendig sowohl zeitlich als auch personell.
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Affiliation(s)
- Stefan Brokatzky
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Kantonsspital St. Gallen, Schweiz
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Factors Associated With the Need for Pharmacological Management of Neonatal Opioid Withdrawal Syndrome. Adv Neonatal Care 2020; 20:364-373. [PMID: 32868586 DOI: 10.1097/anc.0000000000000772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Neonatal opioid withdrawal syndrome (NOWS) is a significant and growing health problem that affects more than 23,000 infants annually, with an estimated hospital cost of more than $720 million. PURPOSE The purpose of this study was to examine factors associated with the need to initiate medication for the treatment of NOWS. METHODS A retrospective review of medical records was conducted of 204 infants born to mothers who used opioids during pregnancy from April 2011 to September 2017. Associations between maternal, infant, and environmental factors and the need for neonatal pharmacological management were examined using χ, t tests, and regression analysis. RESULTS Of 204 neonates exposed to opioids prenatally, 121 (59%) developed symptoms of NOWS, requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages (37.7 weeks vs 36.4 weeks; P < .001), and mothers were present at the neonate's bedside for a lower proportion of their total hospital stay (57% vs 74% of days; P < .001). Maternal factors associated with the need for neonatal medication treatment included the mother's reason for opioid use (P = .014), primary type of opioid used (P < .001), tobacco use (P = .023), and use of benzodiazepines (P = .003). IMPLICATIONS FOR PRACTICE This research provides information regarding the proportion of infants exposed to opioids prenatally who develop NOWS that requires treatment, as well as maternal, infant, and environmental factors associated with the need for neonatal medication use. IMPLICATIONS FOR RESEARCH Future research is needed to examine these relationships prospectively in a larger and more diverse sample.
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Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
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Cochran GT, Hruschak V, Abdullah W, Krans E, Douaihy AB, Bobby S, Fusco R, Tarter R. Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study. J Addict Med 2019; 12:72-79. [PMID: 29140822 PMCID: PMC5786468 DOI: 10.1097/adm.0000000000000370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD. METHODS A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time. RESULTS in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1-0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1-13.0), and depression (OR 7.70, 95% CI 2.4-25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0-0.3, P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI -0.2 to 4.5, P = 0.07). Most study participants achieved adequate or better prenatal care. CONCLUSIONS These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.
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Affiliation(s)
- Gerald T Cochran
- University of Pittsburgh, School of Social Work, Pittsburgh, PA (GC, VH, RF); University of Pittsburgh, School of Medicine, Pittsburgh, PA (GC); UPMC, Magee-Womens Hospital, Pittsburgh, PA (WA); University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA (EK); University of Pittsburgh, School of Medicine, Pittsburgh, PA (ABD); Pregnancy Recovery Center, UPMC, Magee-Womens Hospital, Pittsburgh, PA (SB); University of Pittsburgh, School of Pharmacy, Pittsburgh, PA (RT)
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Whalen BL, Holmes AV, Blythe S. Models of care for neonatal abstinence syndrome: What works? Semin Fetal Neonatal Med 2019; 24:121-132. [PMID: 30926259 DOI: 10.1016/j.siny.2019.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the proportion of infants pharmacologically treated and length of hospital stay. Little remains known about the impact of these varied cared models on maternal-infant attachment and mental health. In this review article, we will propose an optimal model of care to improve short- and long-term outcomes for newborns, their mothers and families, and perinatal care systems.
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Affiliation(s)
- Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Alison V Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, DHMC Pediatrics, One Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Health Research Institute (THRI), Locked Bag 1797, Western Sydney University, Penrith, NSW, 2751, Australia.
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Hernández Núñez J, Valdés Yong M, Suñol Vázquez YDLC, López Quintana MDLC. [Maternal and perinatal risk factors for neonatal morbidity: a narrative literature review]. Medwave 2015; 15:e6182. [PMID: 26247448 DOI: 10.5867/medwave.2015.06.6182] [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: 05/25/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022] Open
Abstract
Newborn diseases increase neonatal mortality rates, so a literature review was conducted to establish the risk factors related to maternal and peripartum morbidity affecting the newborn. We searched the following electronic databases: Cumed, EBSCO, LILACS, IBECS and PubMed/MEDLINE. We used specific terms and Boolean operators in Spanish, Portuguese and English. We included longitudinal and cross-sectional descriptive studies, as well as case-control and cohort studies, systematic reviews and meta-analysis, spanning from 2010 to 2015 that responded the topic of interest. The included studies show that multiple maternal and perinatal conditions are risk factors for significant increase of neonatal morbidity, which are described in this narrative review.
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Affiliation(s)
- Jónathan Hernández Núñez
- Departamento de Obstetricia y Ginecología, Hospital "Alberto Fernández Valdés", Mayabeque, Cuba. Address: Av. 9na entre 24 y 26, Zona de Desarrollo, Santa Cruz del Norte, Mayabeque, Cuba.
| | - Magel Valdés Yong
- Departamento de Obstetricia y Ginecología, Hospital "Dr. Luis Díaz Soto", La Habana, Cuba
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