Maternal, Fetal, and Neonatal Outcomes of Opioid-Dependent Mothers in Iran: A case Study of Iran

Document Type : Original Article

Authors

1 Department of Health Management, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman, Iran

3 Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

10.34172/ahj.1554

Abstract

Background: The present research aimed to identify the maternal, fetal, and neonatal complications experienced by opioid-dependent mothers (ODMs) within the geographical context of Kerman, Iran.
Methods: This study meticulously compared the outcomes of 326 ODMs and an equal number of non-ODMs in Iran, using the data obtained from the Iranian Maternal And Neonatal (IMAN) network, a national health information system in Iran. The selection process involved a census approach, and the participants were carefully matched based on age, gestational age, and nationality. To determine the statistical relationship between opioid dependence during pregnancy and the occurrence of pregnancy and neonatal complications, the chi-square test was employed for analysis.
Findings: Women with ODMs exhibited significantly higher rates of placental abruption (P = 0.01) and chorioamnionitis (P = 0.04) compared to non-ODMs. Neonates born to ODMs had increased risks of adverse outcomes, including neonatal death (P = 0.05), respiratory distress syndrome (RDS) related mortality (P = 0.01), intrauterine growth restriction (IUGR) (P = 0.001), neonatal intensive care unit admission (P < 0.001), hypoglycemia (P = 0.006), neurological complications (P = 0.004), low birth weight (LBW) (P < 0.001), and meconium-stained amniotic fluid (P = 0.001). No significant differences were found in congenital anomalies, Apgar scores, or intrauterine fetal death.
Conclusion: Pregnant women with opioid dependence exhibit a heightened susceptibility to antepartum and postpartum complications compared to their non-opioid-dependent counterparts. The sequelae of these complications may be modulated by the caliber of antenatal care received. This research emphasizes the critical importance of consistent clinical management and robust support systems for this population throughout the gestational period and the puerperium.

Keywords

References

  1. Lind JN, Interrante JD, Ailes EC, Gilboa SM, Khan S, Frey MT, et al. Maternal use of opioids during pregnancy and congenital malformations: a systematic review. Pediatrics. 2017;139(6). doi: 10.1542/peds.2016-4131.
  2. Hensley L, Sulo S, Kozmic S, Parilla BV. Opioid addiction in pregnancy: does depression negatively impact adherence with prenatal care? J Addict Med. 2018;12(1):61-4. doi: 10.1097/ adm.0000000000000364.
  3. Azuine RE, Ji Y, Chang HY, Kim Y, Ji H, DiBari J, et al. Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population. JAMA Netw Open. 2019;2(6):e196405. doi: 10.1001/jamanetworkopen.2019.6405.
  4. Kahila H, Saisto T, Kivitie-Kallio S, Haukkamaa M, Halmesmäki E. A prospective study on buprenorphine use during pregnancy: effects on maternal and neonatal outcome. Acta Obstet Gynecol Scand. 2007;86(2):185-90. doi: 10.1080/00016340601110770.
  5. Burns L, Conroy E, Mattick RP. Infant mortality among women on a methadone program during pregnancy. Drug Alcohol Rev. 2010;29(5):551-6. doi: 10.1111/j.1465-3362.2010.00176.x.
  6. Kelly L, Dooley J, Cromarty H, Minty B, Morgan A, Madden S, et al. Narcotic-exposed neonates in a First Nations population in northwestern Ontario: incidence and implications. Can Fam Physician. 2011;57(11):e441-7.
  7. Khazaee-Pool M, Pashaei T, Nouri R, Taymoori P, Ponnet K. Understanding the relapse process: exploring Iranian women’s substance use experiences. Subst Abuse Treat Prev Policy. 2019;14(1):27. doi: 10.1186/s13011-019-0216-3.
  8. Ghaderi A, Motmaen M, Abdi I, Rasouli-Azad M. Gender differences in substance use patterns and disorders among an Iranian patient sample receiving methadone maintenance treatment. Electron Physician. 2017;9(9):5354-62. doi: 10.19082/5354.
  9. ACOG Committee Opinion No. 423: motivational interviewing: a tool for behavioral change. Obstet Gynecol. 2009;113(1):243-6. doi: 10.1097/AOG.0b013e3181964254.
  10. Sanjanwala AR, Lim G, Krans EE. Opioids and opioid use disorder in pregnancy. Obstet Gynecol Clin North Am. 2023;50(1):229-40. doi: 10.1016/j.ogc.2022.10.015.
  11. Leyenaar JK, Schaefer AP, Wasserman JR, Moen EL, O’Malley AJ, Goodman DC. Infant mortality associated with prenatal opioid exposure. JAMA Pediatr. 2021;175(7):706-14. doi: 10.1001/jamapediatrics.2020.6364.
  12. Witt CE, Rudd KE, Bhatraju P, Rivara FP, Hawes SE, Weiss NS. Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study. J Perinatol. 2017;37(10):1124-9. doi: 10.1038/ jp.2017.106.
  13. Brogly SB, Turner S, Lajkosz K, Davies G, Newman A, Johnson A, et al. Infants born to opioid-dependent women in Ontario, 2002-2014. J Obstet Gynaecol Can. 2017;39(3):157-65. doi: 10.1016/j.jogc.2016.11.009.
  14. Liu AJ, Sithamparanathan S, Jones MP, Cook CM, Nanan R. Growth restriction in pregnancies of opioid-dependent mothers. Arch Dis Child Fetal Neonatal Ed. 2010;95(4):F258- 62. doi: 10.1136/adc.2009.163105.
  15. Nørgaard M, Nielsson MS, Heide-Jørgensen U. Birth and neonatal outcomes following opioid use in pregnancy: a Danish population-based study. Subst Abuse. 2015;9(Suppl 2):5-11. doi: 10.4137/sart.S23547.
  16. Cleary BJ, Donnelly JM, Strawbridge JD, Gallagher PJ, Fahey T, White MJ, et al. Methadone and perinatal outcomes: a retrospective cohort study. Am J Obstet Gynecol. 2011;204(2):139.e1-9. doi: 10.1016/j.ajog.2010.10.004.
  17. Greig E, Ash A, Douiri A. Maternal and neonatal outcomes following methadone substitution during pregnancy. Arch Gynecol Obstet. 2012;286(4):843-51. doi: 10.1007/s00404- 012-2372-9.
  18. Shainker SA, Saia K, Lee-Parritz A. Opioid addiction in pregnancy. Obstet Gynecol Surv. 2012;67(12):817-25. doi: 10.1097/OGX.0b013e3182788e8c.
  19. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014;121(6):1158-65. doi: 10.1097/aln.0000000000000472.
  20. Källén B, Borg N, Reis M. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel). 2013;6(10):1221-86. doi: 10.3390/ph6101221.
  21. Interrante JD, Scroggs SLP, Hogue CJ, Friedman JM, Reefhuis J, Jann MW, et al. Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight. J Opioid Manag. 2021;17(3):215-25. doi: 10.5055/jom.2021.0632.
  22. Tobon AL, Habecker E, Forray A. Opioid use in pregnancy. Curr Psychiatry Rep. 2019;21(12):118. doi: 10.1007/s11920- 019-1110-4.
Addiction & Health
Volume 17
Pages 1-6

Files

Share

How to cite

Statistics