Date of Award

5-2009

Level of Access Assigned by Author

Campus-Only Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Advisor

Nancy Fishwick

Second Committee Member

Marie J. Hayes

Third Committee Member

Peter Millard

Abstract

Opioid dependency in pregnancy has been linked to physical, mental, and psychological problems for the pregnant women and their offspring. To lower health risks, pregnant women who are opioid dependent have been treated with methadone maintenance treatment (MMT), the standard of care since the early 1970s. In 2002, another treatment option became available when the United States (U.S.) Food and Drug Administration (FDA) approved the use of buprenorphine maintenance therapy (BMT) as a treatment for opioid dependence (Rayburn & Bogenschutz, 2004). The effect of these two synthetic opioid replacement therapies in pregnancy on perinatal and neonatal outcomes, particularly neonatal abstinence syndrome (NAS), continues to be controversial and further research is needed (Winklbaur, Jung, & Fischer, 2008). NAS occurs in 50-90% of neonates exposed in-utero to opioids (Levinson-Castel, Merlob, Linder, Siroto, & Klinger, 2006) with a 60% likelihood of requiring pharmacotherapy and an extended hospital stay. Prolonged hospitalization of neonates with NAS impacts newborn attachment and increases health care costs. A retrospective cohort study of 152 opioid dependent pregnant women on MMT (n = 136) or BMT (n =16) was conducted to compare length of hospital stay (LOS) for the neonates. The neonates were born between January 1, 2005 and December 31, 2007. Neonates with an in-utero exposure to BMT as compared to MMT spent fewer days in the hospital (14 days vs. 21 days). The research findings suggest that concomitant exposure to selective serotonin receptor inhibitors (SSRIs) or benzodiazepines with opioid replacement therapy, especially methadone, prolonged LOS for neonates. These findings are consistent with previous research and provide further direction for the treatment of opioid dependency during pregnancy. Harm reduction strategies for opioid dependent pregnant women in substance abuse treatment with either MMT or BMT may one day include recommendations on the concomitant use of benzodiazepines and SSRIs to lower the potential for severe NAS and prolonged hospitalization.

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