Cigarette smoking in opioid-dependent pregnant women: Neonatal and maternal outcomes

• Published in: Drug and alcohol dependence 2013-08, Vol.131 (3), p.271-277
• Main Authors: Jones, Hendrée E, Heil, Sarah H, Tuten, Michelle, Chisolm, Margaret S, Foster, Julianne M, O’Grady, Kevin E, Kaltenbach, Karol
• Format: Article
• Language: English
• Subjects: Adult; Agonist treatment; Analgesics, Opioid - therapeutic use; Antenatal; Buprenorphine; Double-Blind Method; Drug dependency; Female; Humans; Infant, Newborn; Methadone; Neonatal abstinence syndrome; Neonatal Abstinence Syndrome - diagnosis; Neonatal Abstinence Syndrome - epidemiology; Neonate; Opioid dependence; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - drug therapy; Pregnancy Complications - epidemiology; Pregnant women; Prenatal Exposure Delayed Effects - diagnosis; Prenatal Exposure Delayed Effects - epidemiology; Psychiatry; Smoking; Smoking - adverse effects; Smoking - epidemiology; Treatment Outcome; Young Adult
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2012.11.019

Abstract Background The relationship between cigarette smoking and neonatal and maternal clinical outcomes among opioid-agonist-treated pregnant patients is sparse. Objectives (1) Is smoking measured at study entry related to neonatal and maternal outcomes in pregnant women receiving opioid-agonist medication? (2) Is it more informative to use a multi-item measure of smoking dependence or a single-item measure of daily smoking? (3) Is the relationship between smoking at study entry and outcomes different between methadone and buprenorphine? Methods Secondary analyses examined the ability of the tobacco dependence screener (TDS) and self-reported past 30-day daily average number of cigarettes smoked, both measured at study entry, to predict 12 neonatal and 9 maternal outcomes in 131 opioid-agonist-maintained pregnant participants. Results Past 30-day daily average number of cigarettes smoked was significantly positively associated with total amount of morphine (mg) needed to treat neonatal abstinence syndrome (NAS), Adjusted Odds Ratio (AOR) = 1.06 (95% CI: 1.02, 1.09), number of days medicated for NAS, AOR = 1.04 (95% CI: 1.01, 1.06), neonatal length of hospital stay in days, AOR = 1.03 (95% CI: 1.01, 1.05), and negatively associated with 1-AOR = .995 (95% CI: .991,.999) and 5-min Apgar scores, AOR = .996 (95% CI: .994,.998). Simple effect tests of the two significant TDS × medication condition effects found TDS was unrelated to non-normal presentation and amount of voucher money earned in the methadone [AORs = .90 (95% CI: .74, 1.08, p > .24) and 1.0 (95% CI: .97, 1.03, p > .9)] but significant in the buprenorphine condition [AORs = 1.57 (95% CI: 1.01, 2.45, p < .05) and 1.08 (95% CI: 1.04, 1.12, p < .01)]. Conclusions Regardless of prenatal methadone or buprenorphine exposure, heavier cigarette smoking was associated with more compromised birth outcomes.