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USA. Opioid Use Disorders and Medication-Assisted Treatment in Pregnancy

The rate of opioid misuse and dependence is escalating in many communities, including amongst pregnant and parenting women. In addition, substance use treatment systems are reporting increases in the number of individuals seeking treatment for opioid use disorders. Child welfare systems are reporting increases in caseloads, primarily among infants and young children coming into care and hospitals are reporting increases of infants born with neonatal abstinence syndrome. A coordinated, multi-systemic approach that is grounded in early identification and intervention can assist child welfare and treatment systems in conducting both a comprehensive assessment and ensuring access to the range of services needed by families. Collaborative planning and implementation of services are yielding promising results in communities across the country. (SAMHSA - Substance Abuse and Mental Health Services Administration, USA, Stand Februar 2019)

https://ncsacw.samhsa.gov/resources/opioid-use-disorders-and-medication-assisted-treatment/default.aspx

[Increasing Consumption of Crystal Meth in Saxony and its Risks for Mother and Child - Experiences at a Level I Perinatal Center from a Pediatric Viewpoint].

Dinger J, Näther N, Wimberger P, Zimmermann US, Schmitt J, Reichert J, Rüdiger M.

Z Geburtshilfe Neonatol. 2017 Apr;221(2):73-80. doi: 10.1055/s-0043-102953. Epub 2017 May 23. German. 

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/28561211

Trends in pregnancy-associated mortality involving opioids in the United States, 2007-2016.

Gemmill A, Kiang MV, Alexander MJ.

Am J Obstet Gynecol. 2018 Sep 28. pii: S0002-9378(18)30820-2. doi: 10.1016/j.ajog.2018.09.028. 

https://www.ajog.org/article/S0002-9378(18)30820-2/fulltext

WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women.

Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rossler A, Soyka M, Yonkers K.

World J Biol Psychiatry. 2019 Jan 11:1-34. doi: 10.1080/15622975.2018.1510185. 

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/30632868

Prenatal food insecurity associated with severity of neonatal abstinence syndrome 

A new study shows that food insecurity in pregnant women being treated for opioid use disorder may be associated with increased risk for their infants receiving pharmacologic treatment for neonatal abstinence syndrome. Published in Addiction, the Boston Medical Center study indicates that screening for food insecurity in pregnant women who are being treated with opioid agonist therapy (methadone or buprenorphine) for an opioid use disorder could be one way to decrease the severity of neonatal abstinence syndrome in their infants. (Boston Medical Center, USA, 13.11.2018)

https://www.eurekalert.org/pub_releases/2018-11/bmc-pfi111218.php

Medical Specialty of Buprenorphine Prescribers for Pregnant Women with Opioid Use Disorder.

Hollander MAG, Jarlenski MP, Donohue JM, Cole ES, Kelley D, Krans EE.

Am J Obstet Gynecol. 2019 Jan 28. pii: S0002-9378(19)30256-X. doi: 10.1016/j.ajog.2019.01.226. 

https://www.ajog.org/article/S0002-9378(19)30256-X/pdf

USA. Addiction and Pregnancy (Boston Medical Center Themenseite)  

What is Project RESPECT?

Project RESPECT (Recovery, Empowerment, Social Services, Prenatal care, Education, Community and Treatment), is a high risk obstetrical and addiction recovery medical home at Boston Medical Center and Boston University School of Medicine. Project RESPECT provides a unique service of comprehensive obstetric and substance use disorder treatment for pregnant women and their newborns in Massachusetts.  (Stand November 2018)

https://www.bmc.org/obstetrics/pregnancy/addiction

Benzodiazepine withdrawal in pregnant women with opioid use disorders: An observational study of current clinical practices at a tertiary obstetrical hospital.

Gopalan P, Moses-Kolko E, Valpey R, Shenai N, Smith E.

Gen Hosp Psychiatry. 2018 Dec 11;57:29-33. doi: 10.1016/j.genhosppsych.2018.12.005.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/30669023

Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario.

Guan, Q., Sproule, B. A., Vigod, S. N., Cadarette, S. M., Greaves, S., Martins, D., and Gomes, T. (2018) 

Addiction, doi.org/10.1111/add.14453.

Abstract

https://onlinelibrary.wiley.com/doi/10.1111/add.14453

Substanzgebrauch in der Schwangerschaft: Willkommen zur CaSCH-T1 Befragung

Die Forschungsgruppe für Cannabinoide der Ludwig-Maximilians-Universität führt eine vom Bundesministerium für Gesundheit geförderte Studie zum Thema „Substanzgebrauch während der Schwangerschaft“ durch. Der Hintergrund dieser Studie ist zu ermitteln, ob und welchen Substanzgebrauch es während der Schwangerschaft in Deutschland gibt, welche Erfahrungen die Frauen und das medizinische Fachpersonal dazu berichten und ob Auswirkungen des Gebrauchs auf Mutter und Kind zu beobachten sind. Dazu führen wir eine anonymeBefragung von schwangeren Frauen und Müttern sowie Ärztinnen und Ärzten, Hebammen und anderem Fachpersonal durch. Die Beantwortung der Fragen wird ungefähr 10 Minuten dauern.

Ihre Teilnahme wird entscheidend dazu beitragen, einen ersten Eindruck zur Häufigkeit und den Effekten des Substanzgebrauchs während der Schwangerschaft zu erhalten. (LMU – Ludwig Maximilian Universität, Klinikum der Universität München, 2018)

https://www.umfragen-am-klinikum.de/index.php/622226

Opium use during pregnancy and infant size at birth: a cohort study.

Maghsoudlou S, Cnattingius S, Montgomery S, Aarabi M, Semnani S, Wikström AK, Bahmanyar S.

BMC Pregnancy Childbirth. 2018 Oct 1;18(1):358. doi: 10.1186/s12884-018-1994-8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166275/

Risk of preterm and early term birth by maternal drug use.

Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Rand L, Jelliffe-Pawlowski LL.

J Perinatol. 2018 Dec 20. doi: 10.1038/s41372-018-0299-0.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/30573752

Expecting Better - Improving Health and Rights for Pregnant Women Who Use Drugs

Drug use in pregnancy can lead to serious health risks for both the mother and the fetus, including HIV infection and fatal overdose. At the same time, drug use during pregnancy need not lead to any negative outcomes, or to outcomes significantly different from those experienced by non drug-using women. (Open Society Foundations, USA, Oktober 2018)

https://www.opensocietyfoundations.org/sites/default/files/expecting-better-improving-health-and-rights-for-pregnant-women-who-use-drugs-20181016.pdf

USA. Drug Use During Pregnancy Not Child Abuse -Pennsylvania Top Court

(Reuters) - A divided Pennsylvania Supreme Court ruled on Friday that mothers who use illegal drugs during their pregnancies are not committing child abuse against their newly-born children. (Medscape, 31.12.2018)

https://www.medscape.com/viewarticle/907076

Trends and Outcomes Associated With Using Long-Acting Opioids During Delivery Hospitalizations.

Duffy CR, Wright JD, Landau R, Mourad MJ, Siddiq Z, Kern-Goldberger AR, D'Alton ME, Friedman AM.

Obstet Gynecol. 2018 Oct;132(4):937-947. doi: 10.1097/AOG.0000000000002861.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/30204694

USA. Slandering the Unborn - How bad science and a moral panic, fueled in part by the news media, demonized mothers and defamed a generation.

Legislative intrusion into the womb has a long history in the United States, and nowhere is this paternalism more forceful than when illegal drugs are part of the equation. If the country’s war on drugs functions as a system of social control, that control is doubly exercised when a fetus is involved. (New York Times, 28.12.2018)

https://www.nytimes.com/interactive/2018/12/28/opinion/crack-babies-racism.html

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder.

Brogly SB, Saia KE, Werler MM, Regan E, Hernández-Díaz S.

Obstet Gynecol. 2018 Oct;132(4):916-922. doi: 10.1097/AOG.0000000000002881.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/30204704

A retrospective analysis of treatment and retention outcomes of pregnant and/or parenting women with opioid use disorder.

Lopian KM, Chebolu E, Kulak JA, Kahn LS, Blondell RD.

J Subst Abuse Treat. 2019 Feb;97:1-6. doi: 10.1016/j.jsat.2018.11.002. 

Abstract

https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(18)30355-6/fulltext

USA. PERINATAL SUBSTANCE USE - INFOGRAPHICS and SOCIAL MEDIA POSTS

At NPA we know that the language that we use shapes the way we think. We want to change the way we talk about pregnancy and substance use. We encourage you to download, print, and share these with your community. (National Perinatal Asociation, USA)

http://www.nationalperinatal.org/Infographics

Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder.

Bagley SM, Cabral H, Saia K, Brown A, Lloyd-Travaglini C, Walley AY, Rose-Jacobs R.

Addict Sci Clin Pract. 2018 Dec 14;13(1):26. doi: 10.1186/s13722-018-0126-0.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295054/

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues.

Price HR, Collier AC, Wright TE.

Front Pharmacol. 2018 Aug 28;9:961. doi: 10.3389/fphar.2018.00961. eCollection 2018. Review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120972/

Charité: Suchterkrankungen in der Schwangerschaft (Themenseite)

Die Klinik für Geburtsmedizin hat seit Jahren ein bereits in der Schwangerschaft beginnendes Betreuungskonzept für Suchtmittel konsumierende Schwangere etabliert.
Uns ist es wichtig Sie nicht nur zu den sogennanten illegalen Drogen wie Heroin, Kokain, Crystal Meth und Cannabis, sondern insbesondere auch zu Alkohol und Nikotin zu beraten und Ihnen Hilfe anzubieten. (Charité, Berlin, 2018)

https://geburtsmedizin.charite.de/leistungen/suchterkrankungen/

IRIS: Onlineberatung für Schwangere

Für eine gesunde Beziehung zu Ihrem ungeborenen Kind: Wir helfen Ihnen, mit Alkohol und Zigaretten Schluss zu machen.

Schwangeren ist es ein Anliegen, dass ihr Baby gesund zur Welt kommt und sich gut entwickelt. 

Es gibt viel, was Sie als werdende Mutter dafür tun können. Dazu gehört auch, in der Schwangerschaft nicht zu rauchen und keinen Alkohol zu trinken. Das fällt nicht immer ganz leicht. IRIS unterstützt Siedabei, alkohol- und rauchfrei durch Ihre Schwangerschaft zu gehen. (iris-plattform.de, September 2018

https://www.iris-plattform.de/

USA. Caught in Chaos—When Pregnant Women With OUD Are Incarcerated; How OTPs Can Help

This is the story of a young woman with a 15-year history of severe opioid use disorder (OUD), intermittent hospitalization, and incarceration, who becomes pregnant. She has a history of trauma and mental health issues, and few social supports. Her story is the subject of a case report recently published in the Journal of Addiction Medicine. (ATForum, USA, 17.12.2018)

http://atforum.com/2018/12/chaos-pregnant-women-oud-incarcerated/

Perinatal Drug Abuse And Neonatal Drug Withdrawal.

Shukla S, Gomez Pomar E.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.
2018 Jul 27.

https://www.ncbi.nlm.nih.gov/books/NBK519061/

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta-analysis.

Monnelly VJ, Hamilton R, Chappell FM, Mactier H, Boardman JP.

Dev Med Child Neurol. 2018 Dec 3. doi: 10.1111/dmcn.14117.

https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14117

Adverse Pregnancy Outcomes Associated With Gestational Exposure to Antiepileptic Drugs.

Andrade C.

J Clin Psychiatry. 2018 Jul 31;79(4). pii: 18f12467. doi: 10.4088/JCP.18f12467.

http://www.psychiatrist.com/JCP/article/Pages/2018/v79/18f12467.aspx

USA. MATER Center Director, on the Importance of Dr. Finnegan’s Work—Which Continues—and the Need to Treat Mothers for Trauma

Loretta Finnegan, MD, a champion of medication-assisted treatment with methadone, developed her scoring system for newborns more than 40 years ago. The Finnegan Neonatal Abstinence Scoring System (FNASS) assigns a numerical score to 21 clinical signs, and babies are treated accordingly. Developing the test was an important step in making sure that these babies were treated with morphine, if necessary, to manage the symptoms of withdrawal.

But the work of Dr. Finnegan goes far beyond the Finnegan score. When she first started an opioid treatment program (OTP) at Thomas Jefferson University in Philadelphia, 44 years ago, Dr. Finnegan opened a landmark program for pregnant women addicted to opioids. Since then, the program, called Maternal Addiction Treatment Education & Research (MATER), has included intensive outpatient treatment as well as residential treatment.

Diane Abatemarco, PhD, MSW, director of MATER and associate professor of OB/GYN and Pediatrics at the Sidney Kimmel Medical College at Jefferson, talked with AT Forum about the scope and importance of Dr. Finnegan’s work. (ATForum, USA, 17.12.2019)

http://atforum.com/2018/12/mater-center-director-finnegans-work/

Mom's use of opioids in pregnancy may stunt kids' learning

Learning disabilities and other special education needs are common in children born with opioid-related symptoms from their mother's drug use while pregnant, according to the first big U.S. study to examine potential long-term problems in these infants. 

About 1 in 7 affected children required special classroom services for problems including developmental delays and speech or language difficulties, compared with about 1 in 10 children not exposed to opioids before birth, the study found. (MedicalXpress, USA, 30.08.2018)

https://medicalxpress.com/news/2018-08-mom-prenatal-opioids-stunt-kids.html

USA. Healthy Pregnancy Healthy Baby Fact Sheets

This series of four fact sheets emphasizes the importance of continuing a mother's treatment for opioid use disorder (OUD) throughout pregnancy. The series includes information on OUD and pregnancy, OUD treatment, neonatal abstinence syndrome, and considerations to address before hospital discharge. (SAMSHA - Substance Abuse and Mental Health Services Administration, USA, August 2018)

https://store.samhsa.gov/product/Opioid-Use-Disorder-and-Pregnancy/sma18-5071