Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation

The prevalence of opioid use disorder (OUD) during pregnancy is increasing. Practical recommendations will help providers treat pregnant women with OUD and reduce potentially negative health consequences for mother, fetus, and child. This article summarizes the literature review conducted using the RAND/University of California, Los Angeles Appropriateness Method project completed by the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration to obtain current evidence on treatment approaches for pregnant and parenting women with OUD and their infants and children.
Three separate search methods were employed to identify peer-reviewed journal articles providing evidence on treatment methods for women with OUD who are pregnant or parenting, and for their children. Identified articles were reviewed for inclusion per study guidelines and relevant information was abstracted and summarized.
Of the 1697 articles identified, 75 were included in the literature review. The perinatal use of medication for addiction treatment (MAT, also known as medication-assisted treatment), either methadone or buprenorphine, within comprehensive treatment is the most accepted clinical practice, as withdrawal or detoxification risks relapse and treatment dropout. Medication increases may be needed with advancing pregnancy, and are not associated with more severe neonatal abstinence syndrome (NAS). Switching medication prenatally is usually not recommended as it can destabilize opioid abstinence. Postnatally, breastfeeding is seen as beneficial for the infant for women who are maintained on a stable dose of opioid agonist medication. Less is known about ideal pain management and postpartum dosing regimens. NAS appears generally less severe following prenatal exposure to buprenorphine versus methadone. Frontline NAS medication treatments include protocol-driven methadone and morphine dosing in the context of nonpharmacological supports.
Women with OUD can be treated with methadone or buprenorphine during pregnancy. NAS is an expected and manageable condition. Although research has substantially advanced, opportunities to guide future research to improve maternal and infant outcomes are provided.
This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.. http://creativecommons.org/licenses/by-nc-nd/4.0

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Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance.

The role of screening, brief intervention, and referral to treatment in the perinatal period

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine.

Obstetric Care Consensus No. 8: Interpregnancy Care.

Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review

<h3>Objective:</h3> We explore the impact of COVID-19 in pediatric patients with neuroinflammatory disorders and describe parent/guardian vaccination concerns and self-reported side effects of the COVID-19 vaccination. <h3>Background:</h3> Neurological manifestations of COVID-19 in children range from mild to severe. There is limited data surrounding COVID-19 and the COVID-19 vaccine in pediatric populations with known neuroinflammatory disorders. <h3>Design/Methods:</h3> A survey was distributed to guardians of 68 children enrolled in a single center neuroimmunology registry. Clinical data was obtained from the registry. <h3>Results:</h3> 26 (38%) responded to the survey (62% female). Diagnoses included multiple sclerosis (5, 19%), myelin oligodendrocyte glycoprotein antibody-associated disease (8, 31%), acute disseminated encephalomyelitis (1, 4%), autoimmune encephalitis (1, 14%), and other (16, 57%). 10 (38%) had a confirmed COVID-19 diagnosis, and 3 were classified as probable COVID-19 cases based on CDC clinical and exposure criteria. Neurological symptoms in the 6-weeks after confirmed or probable COVID-19 infections were: behavioral changes (4, 31%), paresthesias (1, 8%), taste changes (3, 23%) vision changes (2, 15%) urinary retention (1, 8%), and gait abnormalities (1, 8%). 12 (46%) received at least one COVID-19 vaccine dose. For unvaccinated children, 50% of respondents were “not at all willing” to vaccinate and lack of knowledge of long-term side effects was the most common reason. Neurological side effects in the 6-weeks following the vaccination included: behavioral changes (2, 17%), parasthesias (1, 8%), and gait abnormalities (1, 8%). Of children with confirmed or probable COVID-19 or who received a COVID-19 vaccine, none experienced neurological disease flares requiring treatment alterations or hospitalization. <h3>Conclusions:</h3> Half of children with a neuroinflammatory disease had confirmed or probable COVID-19 and less than half were vaccinated against COVID-19. Children with COVID-19 or who received the COVID-19 vaccine did not have disease flares requiring change in immunotherapy or hospitalization. Guardians are concerned about long term side effects of COVID-19 vaccines. <b>Disclosure:</b> Ms. Bahri has nothing to disclose. Ms. Hurst has nothing to disclose. Ms. Alexander has nothing to disclose. Dr. Hutchinson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Katz, Korin, Cunningham Attorneys At Law. 

Pediatric Neuroinflammatory Disease in the Era of COVID-19: Single Center Survey of the Medical and Social Impact of COVID-19 and COVID-19 Vaccines (S34.006)

Melissa Hutchinson

Papers

Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review

Pediatric Neuroinflammatory Disease in the Era of COVID-19: Single Center Survey of the Medical and Social Impact of COVID-19 and COVID-19 Vaccines (S34.006)