Prenatal Treatment and Outcomes of Women With Opioid Use Disorder
| Autor: | Martha M. Werler, Sonia Hernandez-Diaz, Kelley E Saia, Susan B. Brogly, Emily Regan |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty media_common.quotation_subject MEDLINE Article Young Adult 03 medical and health sciences 0302 clinical medicine Pregnancy Opiate Substitution Treatment medicine Humans Prospective Studies 030212 general & internal medicine Young adult Prospective cohort study media_common 030219 obstetrics & reproductive medicine business.industry Addiction Obstetrics and Gynecology Opioid use disorder Opioid-Related Disorders medicine.disease Buprenorphine Pregnancy Complications Prenatal treatment Female business Methadone |
| Zdroj: | Obstetrics & Gynecology. 132:916-922 |
| ISSN: | 0029-7844 |
| DOI: | 10.1097/aog.0000000000002881 |
| Popis: | OBJECTIVE: To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder. METHODS: Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index (ASI) was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts. RESULTS: Most women in the cohort were non-Hispanic white (80.5%), with a mean age of 28 years. Few women were married (8.9%). Over half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) was infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (26.6%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychological (0.375±0.187) ASI scores were the highest, indicating the most severe problems in these areas. Opioid use–relapse did not differ by treatment (44.7% overall)Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (N=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one still birth), with an overall live-birth rate of 90.8% (95% CI: 82.7, 95.9). CONCLUSIONS: These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population. |
| Databáze: | OpenAIRE |
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