Ludmila N Bakhireva1,2,3, Aydan Sparks4, Michael Herman5, Lauren Hund6, Malia Ashley5,7, Amy Salisbury8. 1. Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, NM, albuquerque, USA. lbakhireva@salud.unm.edu. 2. Department of Family and Community Medicine, School of Medicine, University of New Mexico, NM, albuquerque, USA. lbakhireva@salud.unm.edu. 3. Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, NM, albuquerque, USA. lbakhireva@salud.unm.edu. 4. Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, NM, albuquerque, USA. 5. Department of Pharmacy, University of New Mexico Hospital, NM, albuquerque, USA. 6. School of Law, University of New Mexico, NM, albuquerque, USA. 7. Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, NM, albuquerque, USA. 8. School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.
Abstract
OBJECTIVE: To evaluate the severity of neonatal opioid withdrawal syndrome (NOWS) in infants prenatally exposed to medications for opioid use disorder (MOUD) and serotonin reuptake inhibitors (SRI). METHODS: A prospective cohort included 148 maternal-infant pairs categorized into MOUD (n = 127) and MOUD + SRI (n = 27) groups. NOWS severity was operationalized as the infant's need for pharmacologic treatment with opioids, duration of hospitalization, and duration of treatment. The association between prenatal SRI exposure and the need for pharmacologic treatment (logistic regression), time-to-discharge, and time-to-treatment discontinuation (Cox proportional hazards modeling) was examined after adjusting for the type of maternal MOUD, use of hydroxyzine, other opioids, benzodiazepines/sedatives, alcohol, tobacco, marijuana, gestational age, and breastfeeding. RESULTS: Infants in the MOUD + SRI group were more likely to receive pharmacologic treatment for NOWS (OR = 3.58; 95% CI: 1.31; 9.76) and had a longer hospitalization (median: 11 vs. 6 days; HR = 0.54; 95% CI: 0.33; 0.89) compared to the MOUD group. With respect to time-to-treatment discontinuation, no association was observed in infants who received treatment (HR = 0.59; 95% CI: 0.26, 1.32); however, significant differences were observed in the entire sample (HR = 0.55; 95% CI: 0.34, 0.89). CONCLUSIONS: Use of SRIs among pregnant women on MOUD might be associated with more severe NOWS. IMPACT: A potential drug-drug interaction between maternal SRIs and opioid medications that inhibit the reuptake of serotonin has been hypothesized but not carefully evaluated in clinical studies. Results of this prospective cohort indicate that the use of SRIs among pregnant women on MOUD is associated with more severe neonatal opioid withdrawal syndrome. This is the first prospective study which carefully examined effect modification between the type of maternal MOUD and SRI use on neonatal outcomes. This report lays the foundation for treatment optimization in pregnant women with co-occurring mental health and substance use disorders.
OBJECTIVE: To evaluate the severity of neonatal opioid withdrawal syndrome (NOWS) in infants prenatally exposed to medications for opioid use disorder (MOUD) and serotonin reuptake inhibitors (SRI). METHODS: A prospective cohort included 148 maternal-infant pairs categorized into MOUD (n = 127) and MOUD + SRI (n = 27) groups. NOWS severity was operationalized as the infant's need for pharmacologic treatment with opioids, duration of hospitalization, and duration of treatment. The association between prenatal SRI exposure and the need for pharmacologic treatment (logistic regression), time-to-discharge, and time-to-treatment discontinuation (Cox proportional hazards modeling) was examined after adjusting for the type of maternal MOUD, use of hydroxyzine, other opioids, benzodiazepines/sedatives, alcohol, tobacco, marijuana, gestational age, and breastfeeding. RESULTS: Infants in the MOUD + SRI group were more likely to receive pharmacologic treatment for NOWS (OR = 3.58; 95% CI: 1.31; 9.76) and had a longer hospitalization (median: 11 vs. 6 days; HR = 0.54; 95% CI: 0.33; 0.89) compared to the MOUD group. With respect to time-to-treatment discontinuation, no association was observed in infants who received treatment (HR = 0.59; 95% CI: 0.26, 1.32); however, significant differences were observed in the entire sample (HR = 0.55; 95% CI: 0.34, 0.89). CONCLUSIONS: Use of SRIs among pregnant women on MOUD might be associated with more severe NOWS. IMPACT: A potential drug-drug interaction between maternal SRIs and opioid medications that inhibit the reuptake of serotonin has been hypothesized but not carefully evaluated in clinical studies. Results of this prospective cohort indicate that the use of SRIs among pregnant women on MOUD is associated with more severe neonatal opioid withdrawal syndrome. This is the first prospective study which carefully examined effect modification between the type of maternal MOUD and SRI use on neonatal outcomes. This report lays the foundation for treatment optimization in pregnant women with co-occurring mental health and substance use disorders.
Authors: Tyler N A Winkelman; Nicole Villapiano; Katy B Kozhimannil; Matthew M Davis; Stephen W Patrick Journal: Pediatrics Date: 2018-04 Impact factor: 7.124
Authors: Stephen W Patrick; Judith Dudley; Peter R Martin; Frank E Harrell; Michael D Warren; Katherine E Hartmann; E Wesley Ely; Carlos G Grijalva; William O Cooper Journal: Pediatrics Date: 2015-04-13 Impact factor: 7.124
Authors: Stephen W Patrick; Robert E Schumacher; Brian D Benneyworth; Elizabeth E Krans; Jennifer M McAllister; Matthew M Davis Journal: JAMA Date: 2012-04-30 Impact factor: 56.272
Authors: Ilona A Nekhayeva; Tatiana N Nanovskaya; Sujal V Deshmukh; Olga L Zharikova; Gary D V Hankins; Mahmoud S Ahmed Journal: Biochem Pharmacol Date: 2005-01-01 Impact factor: 5.858
Authors: Emanuel Krebs; Benjamin Enns; Elizabeth Evans; Darren Urada; M Douglas Anglin; Richard A Rawson; Yih-Ing Hser; Bohdan Nosyk Journal: Ann Intern Med Date: 2017-11-21 Impact factor: 25.391