ABSTRACT
OBJECTIVE: To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy. DESIGN: A prospective cohort study over 18 months. SETTING: Northwestern Ontario. PARTICIPANTS: All 600 births at Meno Ya Win Health Centre in Sioux Lookout, Ont, from January 1, 2012, to June 30, 2013, including 166 narcotic-exposed pregnancies. INTERVENTION: Narcotic replacement and tapering of narcotic use with long-acting morphine preparations. MAIN OUTCOME MEASURES: Prenatal management of maternal narcotic use, incidence of neonatal abstinence syndrome, and other neonatal outcomes. RESULTS: The incidence of neonatal abstinence syndrome fell significantly to 18.1% of pregnancies exposed to narcotics (from 29.5% in a previous 2010 study, P = .003) among patients using narcotic replacement and tapering with long-acting morphine preparations. Neonatal outcomes were otherwise equivalent to those of the nonexposed pregnancies. CONCLUSION: In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.
Subject(s)
Delayed-Action Preparations/administration & dosage , Maternal-Fetal Exchange/drug effects , Morphine/administration & dosage , Narcotics/administration & dosage , Neonatal Abstinence Syndrome/epidemiology , Adult , Female , Humans , Incidence , Infant, Newborn , Male , Morphine/toxicity , Narcotics/toxicity , Neonatal Abstinence Syndrome/etiology , Ontario/epidemiology , Opioid-Related Disorders/ethnology , Pregnancy , Pregnancy Complications/chemically induced , Pregnancy Complications/epidemiology , Prospective Studies , Young AdultABSTRACT
OBJECTIVE: To document the incidence and outcomes of narcotic use during pregnancy in northwestern Ontario. DESIGN: Three-year prospective cohort study. SETTING: Sioux Lookout and surrounding communities in northwestern Ontario. PARTICIPANTS: A total of 1206 consecutive births in a catchment area of 28 000 First Nations patients. MAIN OUTCOME MEASURES: Incidence of narcotic use, and maternal and neonatal outcomes. RESULTS: Incidence of narcotic use in pregnancy has risen to 28.6% (P < .001) and incidence of neonatal abstinence syndrome has fallen to 18.0% of narcotic-exposed births (P = .003). Daily intravenous drug use is now a common pattern of abuse. CONCLUSION: Narcotic abuse in pregnancy has dramatically increased in northwestern Ontario. Neonatal outcomes have improved as a result of a family medicine-based prenatal and obstetric program that includes a narcotic replacement and tapering program.
