Hanna Kahila

A prospective study on buprenorphine use during pregnancy: effects on maternal and neonatal outcome.

Background. Exposure to illicit drugs in utero is associated with low birth weight and premature birth. Therefore, maintenance therapy for opioid dependence during pregnancy has been recommended to help withdrawal from street drugs, in order to improve maternal health and decrease risks to the fetus. Methods. In 2002–2005, 67 pregnancies of 66 buprenorphine users were followed prospectively in an outpatient multidisciplinary antenatal setting by an obstetrician, a midwife, a psychiatric nurse and a social worker. Decreasing doses or even abstinence from buprenorphine was encouraged. Outcome measures were daily buprenorphine dose, fetal growth, gestational age at birth, mode of delivery, birth weight, Apgar scores, umbilical pH values, and occurrence of neonatal abstinence syndrome [NAS]. National statistics were used as reference values. Results. The daily dose of buprenorphine decreased by 2.3 mg (median, range increase of 8 mg to decrease of 24 mg). There were no more incidences of premature birth, cesarean section, low Apgar scores (≤6) or umbilical artery pH <7.05 at birth than in the national register, despite the lower birth weight. A total of 91% of the infants needed treatment in a neonatal care unit, 76% had NAS, and 57% needed morphine replacement therapy. Seven infants were taken into care directly from the maternity hospital. Two sudden infant deaths occurred later. Conclusions. The pregnancies and deliveries of buprenorphine‐using women were uneventful, but severe NAS and need for morphine replacement therapy was seen in 57% of the buprenorphine‐exposed newborns. A high number of sudden infant deaths occurred.

Emotional Availability, Parental Self-Efficacy Beliefs, and Child Development in Caregiver-Child Relationships with Buprenorphine-Exposed 3-year-olds

SYNOPSIS Objective . The purpose was to compare emotional availability, maternal self-efficacy beliefs, and child developmental status in caregiver–child relationships with prenatally buprenorphine-exposed and nonexposed 3-year-old children. Design. We compared prenatally buprenorphine-exposed children living either with the biological mother (n = 7) or in foster care (n = 14) to nonexposed participants (n = 13). Emotional availability was coded from videotaped parent-child free-play interactions. Results. After controlling for covariates, buprenorphine-exposed children scored lower on maternal Sensitivity and Nonhostility and child Responsiveness and Involvement as well as lower on the Bayley Cognitive and Language scales than did nonexposed children. As compared to foster mothers, biological mothers scored lower on Sensitivity and Nonhostility and self-efficacy beliefs, and their children scored lower on Responsiveness and the Bayley Cognitive Scale. Regardless of group status, the parenting variables were meaningfully related to child socioemotional variables. Conclusions . Buprenorphine-exposed children experienced more environmental risks in emotional availability and parental self-efficacy and performed worse on the Bayley as compared to nonexposed children.

Risk factors for out‐of‐home custody child care among families with alcohol and substance abuse problems

Aim: To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out‐of‐home care in Finland.

Neonatal outcome of 58 infants exposed to maternal buprenorphine in utero

Aim: To study the neonatal outcome of infants exposed to buprenorphine in utero.

Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: a register-based case-control follow-up study of 524 women.

BACKGROUND A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy. METHODS Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007. RESULTS 7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p<0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5). CONCLUSIONS These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.

Early healthcare utilization and welfare interventions among children of mothers with alcohol and substance abuse: a retrospective cohort study

Aim:  Early childhood healthcare utilization, mortality and welfare interventions were studied among children of mothers with identified gestational alcohol and/or substance abuse.

Prenatal buprenorphine exposure: Effects on biochemical markers of hypoxia and early neonatal outcome

Objective. To evaluate the possible association between prenatal buprenorphine exposure and compromised early neonatal outcome in view of markers of perinatal hypoxia. Design, setting and sample. The study group consisted of 27 full‐term neonates exposed to buprenorphine prenatally and prospectively followed up at a special tertiary outpatient clinic for pregnant drug abusers. Serving as controls were 27 full‐term neonates exposed prenatally to illicit substances other than opioids and 38 full‐term neonates from uncomplicated pregnancies of healthy parturients. Methods and main outcome measures. Apgar scores, cord pH and base excess were recorded. Cord serum samples were collected at birth for analysis of biochemical markers of fetal hypoxic stress: erythropoietin (EPO; chronic hypoxia), cardiac troponin T (cardiac involvement) and S100 (neural damage). Results. All infants were born in good condition according to Apgar scores and pH of cord blood. No statistically significant differences were found between the three groups in cord serum concentrations of EPO (33.0 median, range: 9.0–476.0 U/L in the buprenorphine‐exposed group vs 27.0, range: 8.0–114.0U/L in substance‐abusing controls vs 28.1, range: 11.6–260.0U/L in healthy controls) or S100 (0.47, range: 0.25–0.91µg/L vs 0.40, range: 0.12–1.22µg/L vs 0.47, range: 0.20–2.15µg/L). No significant differences existed in cardiac TnT levels (0.017, range: 0.010–0.072U/L vs 0.010, range: 0.010–0.075U/L vs 0.024, range: 0.010–0.075U/L). Conclusions. While no significant differences in asphyxia markers were observed between the three groups, a tendency towards higher levels of EPO emerged in the buprenorphine‐exposed group.

Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions

Aim:  To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse.