Tags

Type your tag names separated by a space and hit enter

Maternal opioid use disorder and neonatal abstinence syndrome in northwest Ontario: a 7-year retrospective analysis.
Can J Rural Med. 2018 Spring; 23(2):39-44.CJ

Abstract

INTRODUCTION

Opioid use in pregnancy is increasing globally. In northwest Ontario, rates of neonatal abstinence syndrome (NAS) are alarmingly high. We sought to document the increasing rates of opioid exposure during pregnancy and associated cases of NAS over a 7-year period in northwest Ontario.

METHODS

We conducted a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre catchment area (population 29 000) maternity program in northwest Ontario of mother-infant dyads of live births from Jan. 1, 2009, to Dec. 31, 2015. The Integrated Pregnancy Program provides maternal, neonatal and addiction care for obstetrical patients at the health centre. We collected data on prenatal opioid exposure due to illicit and opioid agonist therapy (OAT) from patient/prescription histories and urine toxicology reports. Rates of NAS (diagnosed as a Finnegan score > 7) were recorded retrospectively from neonatal hospital charts.

RESULTS

There were 2743 live births during the study period. Opioid exposure occurred in 672 pregnancies (335 OAT, 337 illicit). The incidence of prenatal opioid exposure increased significantly between 2009 and 2012 (11.1% to 28.5%, p < 0.001) but remained relatively constant at around 30% thereafter. Despite this, absolute rates of NAS remained relatively stable, with an average of 22.2 cases per 1000 live births over the study period. In comparison, the North West Local Health Integration Network (LHIN) experienced an average of 52.8 cases of NAS per 1000 live births in 2009-2012. The incidence of NAS in our centre decreased significantly over the study period (17.6% of opioid-exposed pregnancies in 2009 v. 4.0% in 2015, p = 0.001). There was a gradual transition toward a preponderance of OAT- versus illicit-exposed pregnancies, increasing from 0% in 2009 to 76.9% in 2015 (p < 0.001).

CONCLUSION

Despite our continually increasing rates of opioid exposure in pregnancy, rates of NAS decreased annually and were substantially lower than those of our regional LHIN. In contrast to 2009, most opioid exposure in our region is now iatrogenic as a result of OAT. These improvements may be attributable in part to the rural community-based prenatal and addictions services developed in our catchment area.

Authors+Show Affiliations

Associate Professor, Northern Ontario School of Medicine; Chief of Obstetrics, Sioux Lookout Men Ya Win Health Centre, Sioux Lookout, Ont.Research Assistant, Anishnaabe Bimaadiziwin Research Program, Sioux Lookout, Ont.Assistant Professor, Northern Ontario School of Medicine, Sioux Lookout, Ont.Assistant Professor, Northern Ontario School of Medicine, Sioux Lookout, Ont.Epidemiologist, Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.Research Methodologist, Kingston General Hospital Research Institute; Department of Public Health Sciences, Queen's University, Kingston, Ont.Research Consultant, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29547380

Citation

Dooley, Joe, et al. "Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome in Northwest Ontario: a 7-year Retrospective Analysis." Canadian Journal of Rural Medicine : the Official Journal of the Society of Rural Physicians of Canada = Journal Canadien De La Medecine Rurale : Le Journal Officiel De La Societe De Medecine Rurale Du Canada, vol. 23, no. 2, 2018, pp. 39-44.
Dooley J, Ryan G, Gerber Finn L, et al. Maternal opioid use disorder and neonatal abstinence syndrome in northwest Ontario: a 7-year retrospective analysis. Can J Rural Med. 2018;23(2):39-44.
Dooley, J., Ryan, G., Gerber Finn, L., Bollinger, M., Matsumoto, C. L., Hopman, W. M., & Kelly, L. (2018). Maternal opioid use disorder and neonatal abstinence syndrome in northwest Ontario: a 7-year retrospective analysis. Canadian Journal of Rural Medicine : the Official Journal of the Society of Rural Physicians of Canada = Journal Canadien De La Medecine Rurale : Le Journal Officiel De La Societe De Medecine Rurale Du Canada, 23(2), 39-44.
Dooley J, et al. Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome in Northwest Ontario: a 7-year Retrospective Analysis. Can J Rural Med. 2018;23(2):39-44. PubMed PMID: 29547380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal opioid use disorder and neonatal abstinence syndrome in northwest Ontario: a 7-year retrospective analysis. AU - Dooley,Joe, AU - Ryan,Gareth, AU - Gerber Finn,Lianne, AU - Bollinger,Megan, AU - Matsumoto,Cai-Lei, AU - Hopman,Wilma M, AU - Kelly,Len, PY - 2018/3/17/entrez PY - 2018/3/17/pubmed PY - 2018/10/4/medline SP - 39 EP - 44 JF - Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale : le journal officiel de la Societe de medecine rurale du Canada JO - Can J Rural Med VL - 23 IS - 2 N2 - INTRODUCTION: Opioid use in pregnancy is increasing globally. In northwest Ontario, rates of neonatal abstinence syndrome (NAS) are alarmingly high. We sought to document the increasing rates of opioid exposure during pregnancy and associated cases of NAS over a 7-year period in northwest Ontario. METHODS: We conducted a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre catchment area (population 29 000) maternity program in northwest Ontario of mother-infant dyads of live births from Jan. 1, 2009, to Dec. 31, 2015. The Integrated Pregnancy Program provides maternal, neonatal and addiction care for obstetrical patients at the health centre. We collected data on prenatal opioid exposure due to illicit and opioid agonist therapy (OAT) from patient/prescription histories and urine toxicology reports. Rates of NAS (diagnosed as a Finnegan score > 7) were recorded retrospectively from neonatal hospital charts. RESULTS: There were 2743 live births during the study period. Opioid exposure occurred in 672 pregnancies (335 OAT, 337 illicit). The incidence of prenatal opioid exposure increased significantly between 2009 and 2012 (11.1% to 28.5%, p < 0.001) but remained relatively constant at around 30% thereafter. Despite this, absolute rates of NAS remained relatively stable, with an average of 22.2 cases per 1000 live births over the study period. In comparison, the North West Local Health Integration Network (LHIN) experienced an average of 52.8 cases of NAS per 1000 live births in 2009-2012. The incidence of NAS in our centre decreased significantly over the study period (17.6% of opioid-exposed pregnancies in 2009 v. 4.0% in 2015, p = 0.001). There was a gradual transition toward a preponderance of OAT- versus illicit-exposed pregnancies, increasing from 0% in 2009 to 76.9% in 2015 (p < 0.001). CONCLUSION: Despite our continually increasing rates of opioid exposure in pregnancy, rates of NAS decreased annually and were substantially lower than those of our regional LHIN. In contrast to 2009, most opioid exposure in our region is now iatrogenic as a result of OAT. These improvements may be attributable in part to the rural community-based prenatal and addictions services developed in our catchment area. SN - 1488-237X UR - https://www.unboundmedicine.com/medline/citation/29547380/Maternal_opioid_use_disorder_and_neonatal_abstinence_syndrome_in_northwest_Ontario:_a_7_year_retrospective_analysis_ L2 - https://medlineplus.gov/opioidmisuseandaddiction.html DB - PRIME DP - Unbound Medicine ER -