Study: More Expectant Moms Using Meth, Opioids

Meth and opioid use among expectant moms has grown significantly in the U.S. over a decade, a new study suggests, and the use is associated with worse outcomes compared with other baby deliveries.

The findings – published this week in the American Journal of Public Health – highlight the nation’s current drug crisis and appear to echo national trends in drug use.

“Basically what we found is amphetamine and opioid use disorders are increasing among delivering women in the U.S., and they’re increasing disproportionately across rural compared to urban counties across most of the United States,” says Dr. Lindsay Admon, an OB-GYN at Michigan Medicine Von Voigtlander Women’s Hospital and the lead author of the study.  “When we compared delivery-related outcomes, or birth outcomes, among moms with opioid and amphetamine use disorders, outcomes were actually much worse with methamphetamine use disorders compared to opioid use disorders.”

Baby in baby hat

Using data from the federal Agency for Healthcare Research and Quality, Admon and fellow researchers examined the trends in rates of amphetamine- and opioid-affected births in the U.S. from 2004 to 2015, drilling down to incidence by census region and among rural and urban residents.

The researchers noted that while they could not distinguish between methamphetamine use and other categories of amphetamine use, recent data show that “the majority (94 percent) of individuals with amphetamine use disorders seek care for methamphetamine-related use.”

The analysis revealed that from the 2008-2009 period to the 2014-2015 period, the estimated rate of amphetamine use among pregnant women across the U.S. doubled, from 1.2 per 1,000 hospital deliveries affected to 2.4. The rate of opioid-affected births more than quadrupled, from 1.5 per 1,000 deliveries to 6.5.

Researchers found that amphetamine- and opioid-related deliveries were both associated with worse health outcomes, longer lengths of stay and higher delivery costs than other hospital deliveries. Amphetamine-related deliveries were associated with higher rates of preeclampsia, placental abruption, preterm delivery and severe maternal morbidity and mortality than all other deliveries.

The adverse outcomes could be directly related to the drug use, researchers said, though they also noted that other factors may play a role. Substance use, for example, is associated with later prenatal care and fewer prenatal appointments, and access to treatment for pregnant women with addiction is often insufficient, especially in rural areas, the study said.

Higher rates for use of both amphetamines and opioids among pregnant women also varied by geographic location.

Happy baby

“By 2014 to 2015, amphetamine use disorder was identified among approximately 1 percent of deliveries in the rural Western United States, and that was higher than the incidence of opioid use in most other regions,” Admon says. Meanwhile, the incidence of opioid use disorder was estimated at 3 percent of all deliveries in the rural Northeast, higher than previously estimated, she says.

“When we looked into it, it’s been over 10 years since anybody has really looked at trends of amphetamine use, or methamphetamine use, in pregnancy, so these findings were really startling to us,” Admon says.

Still, Admon says she thinks her group’s estimates are probably conservative, as they rely on conditions such as clinicians screening for drug use, patients’ disclosure of substance use and proper recording of diagnoses.

“With substance use, it’s not just the opioid epidemic. There are other substances such as methamphetamine use that are also increasing, and I think we really need to think carefully about ways to connect women with the treatment resources that they need,” Admon says. “We have these really clear treatment guidelines for treating patients with opioid use disorder, and we don’t have the same type of guidance, certainly not in obstetrics, about how to best treat women with amphetamine use disorder, and I think there’s definitely a need for that.”

By Katelyn Newman, Staff WriterNov. 30, 2018, at 1:54 p.m.

Original article here posted on:

Mother and Baby Hospital

Newborn Opioid Withdrawal Requires a ‘Cascade of Care,’ Study Suggests

Effective management of neonatal abstinence syndrome (NAS) — withdrawal symptoms occurring in infants exposed to opioids in utero — requires a coordinated “cascade of care” from prevention through long-term follow-up, reports a study in Advances in Neonatal Care, official journal of the National Association of Neonatal Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Based on interviews with frontline providers caring for infants affected by NAS, the researchers identify four essential areas to improve care for this increasingly common complication of opioid use. “Greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS,” write Jennifer L. Syvertsen, PhD, MPH, of the University of California, Riverside and colleagues at the University of Southern California.

Critical Areas to Improve Care for Infants Exposed to Opioids

Neonatal abstinence syndrome (NAS) can result from legally prescribed opioid medications, misuse of prescription opioids, illicit drugs such as heroin, or medication-assisted therapy to treat opioid use disorders, including Suboxone or methadone. Infants exposed to any of these forms of opioids during gestation are at risk of NAS, developing signs and symptoms of opioid withdrawal after birth. Timely and effective care can lower the impact and costs of NAS. However, standardized care and treatment resources are often lacking, both for women and their infants affected by NAS.

Happy baby

The researchers conducted in-depth interviews with 18 central Ohio healthcare providers caring for infants and families affected by NAS. Ohio has among the highest rates of opioid use and NAS in the United States. In 2015, nearly 2,200 infants were hospitalized for NAS, at a cost of over $133 million. “Rather than an acute diagnosis, we propose that NAS is better conceptualized as cascade of care — and there is a need to better coordinate and provide care at each stage of the cascade,” Dr. Syvertsen and coauthors write. Informed by analysis of the provider interviews, the researchers discuss four interrelated components of the cascade of care:

  • Prevention. Care begins with preventing the misuse of opioids and other drugs. Preventive efforts should encompass the “social determinants of health” such as poverty, lack of education, and limited opportunities. “Although there is an urgent need for prevention programming and drug treatment, current resources do not meet the demand,” the researchers write.
  • Prenatal Care and Drug Treatment. The providers stressed the need for supportive care for pregnant women using opioids, rather than punitive approaches. While comprehensive care programs have yielded promising results, NAS can occur even in infants born to mothers receiving recommended medication-assisted treatment for opioid use disorder. “Barriers in communication and a shortage of integrative prenatal programs to address opioid use in pregnancy often leave women confused and frustrated about a subsequent NAS diagnosis at the hospital,” Dr. Syvertsen and colleagues write.
  • Labor and Delivery. Infants must be monitored for signs of NAS, with treatment if needed; providers stressed that consistency in following protocols is critical to reducing infant length of stay in the hospital. Programs to sensitize staff and mitigate stereotyping attitudes toward the mothers of babies with NAS have led to better care. In rural areas, the infant has to be transported to a higher-level newborn intensive care unit, creating barriers to mother-infant bonding.
  • Aftercare. Supportive aftercare includes access to drug treatment and social services, monitoring the child’s development, and providing a healthy home environment for the infant to thrive. The providers cited variations in policies and procedures, noting that available resources are stretched to the limit. While services are available for pregnant women, all too often they “shut down” after delivery.

“Our current focus on the period of pregnancy alone is insufficient to address the complexity of NAS,” Dr. Syvertsen and colleagues write. Their article provides examples of interview quotes illustrating each of the four elements of the cascade of care and important subthemes.

Dr. Syvertsen and coauthors highlight the need for programs and policy at each stage of the cascade, toward the critical goal of stemming the tide of NAS. They conclude: “Unless we make a serious political commitment to create fair drug policy, adapt a more integrative approach to addressing NAS, and adequately support the initiatives that we know can work, NAS incidence will continue to rise and devastate communities.”

Original article here.

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Journal Reference:

  1. Syvertsen, Jennifer L.; Toneff, Hannah; Madden, Danielle R.; Clapp, John D. Conceptualizing Neonatal Abstinence Syndrome as a Cascade of Care: A Qualitative Study With Healthcare Providers in Ohio. Advances in Neonatal Care, 2018; DOI.

 

Baby Hand Holding Adult Hand

Cincinnati Children’s Study Shows Opioid-Exposed Babies at Risk for Developmental Delays

A new study from Cincinnati Children’s Hospital Medical Center shows that newborns who require treatment for opioid withdrawal are at higher risk than others for delayed language, cognitive and motor skills.

Cincinnati Children’s this week released the study of 87 children who have been treated at its long-term Neonatal Abstinence Syndrome Clinic.

The study looked at neurodevelopment of 2-year-olds who’d been treated for the syndrome that can occur in newborns who were exposed to opioids in utero. Some of the mothers had taken heroin while pregnant; others were prescribed opioid medication for the addiction.

“These children are at risk for developmental delay,” said Dr. Stephanie Merhar, a neonatologist at Cincinnati Children’s and the lead author of the neurodevelopmental study.

They also have higher rates of what’s called strabismus, commonly known as crossed eyes, than the general population.

Some NAS toddlers – including Ava, 2, of Reading – experience one significant delay but none of the others. Hers is language development.

Toddler Ava

Ava loves to spin around, climb, feed her family’s fish, and listen and dance to toddler-rated YouTube songs. But she will often point and scream when she wants something because she does not speak words.

Ava was treated for opioid withdrawal when she was born July 22, 2016, at St. Elizabeth Edgewood Hospital. Her adoptive mother, Meichelle Hunley of Reading, has had Ava since she was two days old.

“She’s about a year and a half behind in her speech,” Hunley said.

The communication barrier has been frustrating for Ava, who seems to understand everything, her mom said.

Ava was not among the 2-year-olds who were part of the Children’s Hospital study, but she received the same assessment as those toddlers did: the Bayley Scales of Infant and Toddler Development.

Merhar said the recent study found that the test scores of toddlers were “significantly” lower than national averages. But she noted that it’s not clear whether the children’s intelligence or academic performance will be affected later on, in school.

The toddlers generally fell within the lower part of the “normal” range in their scores.

“These are not the kids who are so obviously developmentally delayed,” Merhar said. “You might not know it.”

The study showed that 2-year-olds who had been living with foster or adoptive families were more likely to have higher cognitive scores. The result indicates to researchers that there might be a socioeconomic factor involved in the children’s development, Merhar said.

The study doesn’t suggest the infants should be removed from their biological families, she said, but instead that their families should be provided supports to raise them.

Merhar said the study shows that babies who were exposed in utero to opioids should be monitored closely and provided with medical intervention as needed as they grow.

“We encourage close medical follow up and screening early-on for delays,” she said.

That’s just what has happened with Ava. She goes to Cincinnati Children’s Mason clinic for speech therapy. She is learning sign language and has begun using cards to identify objects.

Ava also has home visits from an Ohio Health Department program called Help Me Grow. She’ll be enrolled in preschool in Reading Community Schools this fall, at 3 years old, to give her a jump on learning, Hunley said.

Merhar said few neurodevelopmental studies have been undertaken in the United States on toddlers who were treated for Neonatal Abstinence Syndrome from opioids.

Dr. Jennifer McAllister, a co-director of Children’s NAS follow-up clinic, said she’s aware of one larger study than the Children’s Hospital study, and it focused on school-aged children.

The Cincinnati Children’s study on Neonatal Abstinence Syndrome is published online in the Journal of Perinatology.

Original article here on Cincinnati.com.