DRUGS IN PREGNANCYObstetrical and Neonatal Outcomes of Methadone-Maintained Pregnant Women: A Canadian Multisite Cohort Study
Section snippets
INTRODUCTION
The prevalence of perinatal opioid use has been increasing over the past decade.1., 2., 3. Opioid use during pregnancy can lead to adverse obstetrical and neonatal outcomes, including an increased risk of intrauterine growth restriction, prematurity, and neonatal abstinence syndrome.4 Data from the Canadian Institute for Health Information have demonstrated that the incidence of NAS in Ontario increased from 1.3 to 3.2 cases per 1000 deliveries over the five-year period from 2004 to 2009.3
METHODS
We conducted a multisite retrospective review of the medical records of methadone-maintained pregnant women attending integrated care programs from 1997 to 2009 in three cities (Vancouver, Toronto, and Montreal). The programs were the Sheway clinic in Vancouver, the Toronto Centre for Substance Use in Pregnancy, and the Herzl Family Practice Centre in Montreal. T-CUP and the Herzl Clinic are both hospital-based centres, whereas Sheway is a community-based clinic. These programs reduce barriers
RESULTS
A total of 94 women were included in this study: 36 from Toronto, 36 from Vancouver, and 22 from Montreal. We excluded eight women who attended the Toronto program but for whom documentation relating to delivery and neonatal outcome was not available for review because they delivered at an external hospital.
Maternal demographic data are presented in Table 1. Significant inter-site differences were found in ethnicity and marital status. Women in Montreal were more likely to have partners than
DISCUSSION
These data provide an overview of obstetrical and neonatal outcomes for a national cohort of pregnant women on MMT. Differences in obstetrical outcomes are mostly related to maternal demographics and rates of maternal substance use. As previously reported,6 this sample of pregnant women used multiple substances including heroin, prescription opioids, nicotine, cocaine, marijuana, and benzodiazepines during pregnancy. This pattern of substance use is common among opioid-dependent women.5 The
CONCLUSION
In this Canadian cohort of pregnant methadone-maintained women, opioid maintenance therapy as part of an integrated care program provided satisfactory maternal, obstetrical, and neonatal outcomes. Obstetrical complications were infrequent with most infants born at term. NAS is the most significant adverse consequence of MMT during pregnancy only because of the need for prolonged hospital stay and the potential need for pharmacological treatment. Policies promoting maternal–newborn contact,
ACKNOWLEDGEMENTS
Grant support was received from the Lawson Foundation to assist with data collection. The authors wish to thank Talar Boyajian and Hee Yung Lim for assistance with data entry and Dr Rahim Moineddin for advice with data analysis.
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Cited by (25)
Reduction of need for treatment and length of hospital stay following institution of a neonatal abstinence syndrome rooming-in program in Ontario, Canada
2021, Journal of Pediatric NursingCitation Excerpt :These infants also experience an increase in severity of NAS symptoms and require greater amounts of pharmacotherapy along with prolonged hospitalization (Abrahams et al., 2007; Hunseler et al., 2013; McKnight et al., 2016). Newly implemented rooming in programs have allowed infants of opioid-dependent mothers to stay in the same room as their mother while the infant continues to be monitored for signs of NAS (Abrahams et al., 2007; 2010; Dow et al., 2012; Government of Ontario, 2010; Hunseler et al., 2013; Kirchner et al., 2014; McKnight et al., 2016; Newman et al., 2015; Ordean et al., 2015; Saiki et al., 2010). New data is showing the benefits of rooming-in and its effectiveness on promoting mothering, reducing pharmacologic treatment, lessening duration of treatment, and decreasing the length of stay in hospital (Abrahams et al., 2010; Bagley et al., 2014; Grossman et al., 2017; Hunseler et al., 2013; McKnight et al., 2016; Newman et al., 2015; Ordean et al., 2015; Saiki et al., 2010; Whalen et al., 2019).
Prenatal Care Outcomes in Women with Substance Use Disorders: A Retrospective Cohort Study
2021, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Several small studies have demonstrated the efficacy of integrated programs in reducing maternal substance use and have shown satisfactory neonatal outcomes.2,9,10 Only 2 studies have specifically examined obstetrical outcomes.2,11 In the only Canadian study that examined prenatal care outcomes, the majority of women with SUD presented to care in the second or third trimester and were engaged in care for a mean of 139 days.2
Models of care for opioid dependent pregnant women
2019, Seminars in PerinatologyCitation Excerpt :The group also had a lower incidence of birth by cesarean delivery than the Canadian national average.39 Birth data for the cohort also showed longer gestation and less pharmacologic treatment of neonatal abstinence syndrome.39 The Dartmouth–Hitchcock Medical Center Perinatal Addiction Program was started in 2013 in response to the growing number of pregnant women disclosing opioid use disorders and the limited available treatment options.40
Trends in incidence of neonatal abstinence syndrome in Canada and associated healthcare resource utilization
2018, Drug and Alcohol DependenceCare Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss
2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingNo. 349-Substance Use in Pregnancy
2017, Journal of Obstetrics and Gynaecology Canada
Competing Interests: None declared.