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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Kaolin and pectin are combined with opium and belladonna (Amogel-PG, Donnagel-PG, Donnapectolin-PG, Quiagel-PG) and with paregoric (kapectolin with paregoric, parepectolin). The addition of belladonna and opioid agents results in decreased gastrointestinal mobility. Use of opioids in pregnant women may pose a risk of birth defects if used chronically in the first trimester (see Chapter 8). Only 36 women were exposed during early pregnancy were included in the Collaborative Perinatal Project database; no evidence of a significant increase in the frequency of congenital anomalies was found in this small sample (Heinonen et al., 1977). Almost 100 women were exposed to paregoric in early pregnancy with no significant increase in frequency of congenital anomalies (Aselton et al., 1985). However, the possibility exists of addiction and subsequent neonatal abstinence syndrome in neonates whose mothers use opioid agents chronically.
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The neonatal abstinence syndrome (NAS) is the most serious complication arising from the maternal use of opiates (heroin and/or opiates of substitution such as methadone or high-dose buprenorphine), with an incidence of 40 to 90% in neonates born to addicted mothers in this group. The syndrome manifests itself most frequently during the first 24 to 36 hours of life for heroin and highdose buprenorphine, and appears later for methadone, between the second and seventh day [1,2].
Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
PregnancyThe UK Chief Medical Officers recommend not drinking alcohol at all during pregnancy.Alcohol detoxification should use chlordiazepoxide or diazepam, preferably as an inpatient.BAPAvoid medications for preventing alcohol relapse.BAPNRT may pose a risk to the foetus, but likely less harmful than smoking. First line: psychosocial interventions. Second line: NRT after risk-benefit analysis. Avoid varenicline and bupropion.BAPFor opioid dependence, offer methadone or buprenorphine substitution (but not buprenorphine/naloxone)BAP: Buprenorphine may result in milder neonatal abstinence syndrome compared to methadone.BAPDetoxification should be avoided in the first trimester and is cautioned in the third trimester: best time is second trimester.BAP
Interlocking theories and practice in treatment and recovery for women with opioid use disorders
Published in Journal of Social Work Practice in the Addictions, 2022
Vickie Harden, Isabela Romas, Jude Romines, Marva Lewis
Maternal opioid use disorders affect entire family systems. Social workers and other helping professionals should address this epidemic from a family systems perspective. A structural family systems perspective provides an intergenerational framework for social workers to assess family risk and protective factors (Hoffman, 1981). Adults living with children report more barriers to treatment than adults without children, though four out of ten adults with opioid use disorders have children (Feder et al., 2018). More specifically, the mother-infant dyad is negatively influenced in several ways due to a mother’s opioid use disorder. While the infant is experiencing symptoms related to Neonatal Abstinence Syndrome (NAS), the mother may also be experiencing significant social and emotional distress (Velez & Jansson, 2008). The necessary attachment process may be infringed upon, leaving both infant and mother without anchoring attachment behaviors from which to promote parent-child bonding. Attachment theory provides a framework by which to understand the post-partum addictions recovery process and the impact on family systems.
Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women
Published in International Review of Psychiatry, 2021
Dennis J. Hand, Alice C. Fischer, Meghan L. Gannon, Kimberly A. McLaughlin, Vanessa L. Short, Diane J. Abatemarco
The United States’ ongoing overdose crisis claimed over 67,000 lives in 2018, with opioids involved in nearly 70% of deaths (Wilson et al., 2020). Opioid use disorder (OUD) has historically been less prevalent among women, but increased at a faster rate among women compared to men between 2002 and 2013 (Jones et al., 2015). Among pregnant women, the prevalence of OUD at delivery increased fourfold between 1999 and 2014 (Haight et al., 2018). Within a similar timeframe (1999–2013), the incidence of neonatal abstinence syndrome (NAS) concomitantly increased from 1.5 to 6.0 per 1000 births (Ko et al., 2016). After delivery, rates of maternal overdose increase substantially through 12 months postpartum (Schiff et al., 2018). Treatment for OUD among reproductive-aged women must be responsive to differing needs across life stages due to the significant rates and impacts of OUD before and after pregnancy. Furthermore, a comprehensive response that addresses factors that underlie OUD and other substance use disorders (SUDs) is necessary to promote whole-person wellness, build resilience in families, and prevent intergenerational transmission of SUDs.
Long-time effects of prenatal morphine, tramadol, methadone, and buprenorphine exposure on seizure and anxiety in immature rats
Published in International Journal of Neuroscience, 2020
Morteza Gholami, Ehsan Saboory, Ali Asghar Ahmadi, Mohsen Asouri, Mehrab Nasirikenari, Mostafa Rostamnezhad
Tramadol is an atypical opioid analgesic, also considered as an antidepressant with a dual action: a weak affinity for the opioid µ receptor, and the inhibition of noradrenaline and serotonin reuptake [25,26]. During gestation, the duration of treatment with tramadol should be limited [27]. If a toxic dosage of tramadol is administered (toxicity may be related to the inhibition of monoamine reuptake) or is taken with seizure-inducing drugs, it can excite epilepsy in both humans and animals [28]. Buprenorphine has a partial agonistic and antagonist effect, respectively, on µ-opioid and κ-opioid receptors [29,30]. Methadone is a typical non-phenanthrene opioid-like morphine [31]. It can cross the placental barrier and is distributed in the fetal brain which may result in variable and unpredictable behavioral disorders in the newborns [32]. It has been reported that methadone produces a dose-dependent reduction in the threshold of PTZ-induced seizures in adult albino mice [33]. Methadone and buprenorphine are employed as first-line medications in the treatment of opioid dependence [34,35], and both drugs are the preferred therapeutic option for opioid replacement in pregnant women [36]. However, pregnant women maintained on an opioid replacement therapy put their immature offspring at the risk of developing neonatal abstinence syndrome (NAS), a postnatal drug withdrawal syndrome primarily owing to maternal opiate use [37].