TY - JOUR T1 - Methadone Dosing and Prescribed Medication Use in a Prospective Cohort of Opioid-Dependent Pregnant Women JF - Addiction Y1 - 2013 A1 - Cleary, B A1 - Murphy, Deirdre J A1 - Gallagher, Paul J A1 - Fahey, T KW - Dosage KW - dosing KW - Methadone KW - Neonatal Abstinence Syndrome KW - Pregnancy KW - withdrawal AB - Aims This study aimed to (i) describe methadone dosing before, during and after pregnancy, (ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with dose decreases and those with steady or increasing doses and (iii) to describe prescribed medication use among opioid-dependent pregnant women. Design Prospective cohort study. Setting Two Irish tertiary care maternity hospitals. Participants A total of 117 pregnant women on methadone maintenance treatment (MMT) recruited between July 2009 and July 2010. Measurements Electronic dispensing records from addiction clinics and the Primary Care Reimbursement Service were used to determine methadone doses and dispensed medications in the year preceding and the month following delivery. The Finnegan score was used to determine need for medical treatment of NAS. Findings Of the 117 participants, sufficient dosing data were available for 89 women treated with MMT throughout pregnancy; 36 (40.4%) had their dose decreased from a mean pre-pregnancy dose of 73.3 mg [standard deviation (SD) 25.5] to a third-trimester dose of 58.0 mg (SD 26.0). The corresponding figures for those with increased doses (n = 31, 34.8%) were 70.7 mg (SD 25.3) and 89.7 mg (SD 21.0), respectively. The incidence of medically treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29 women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to postpartum. Benzodiazepines were prescribed for 43 women (38.0%). Conclusion In the Irish health service, opioid-dependent women frequently have their methadone dose decreased during pregnancy but this does not appear to affect the incidence of the neonatal abstinence syndrome in their babies VL - 108 UR - http://www.ncbi.nlm.nih.gov/pubmed/23216809 IS - 7 ER - TY - JOUR T1 - Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis JF - Addiction Y1 - 2010 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Clarke, Mike A1 - Murphy, Deirdre J KW - Cohort Studies KW - Databases, Bibliographic KW - Dose-Response Relationship, Drug KW - Female KW - Humans KW - Infant, Newborn KW - Methadone KW - Narcotics KW - Neonatal Abstinence Syndrome KW - Opioid-Related Disorders KW - Pregnancy KW - Pregnancy Complications KW - Prenatal Exposure Delayed Effects KW - Randomized Controlled Trials as Topic KW - Severity of Illness Index AB - AIM: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). METHODS: PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. RESULTS: A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. CONCLUSIONS: Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy. VL - 105 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03120.x/abstract IS - 12 ER - TY - JOUR T1 - Methadone and perinatal outcomes: a retrospective cohort study JF - Am J Obstet Gynecol Y1 - 2011 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - White, Martin J A1 - Murphy, Deirdre J KW - Age Factors KW - Dose-Response Relationship, Drug KW - Female KW - Humans KW - Infant, Newborn KW - Methadone KW - Narcotics KW - Neonatal Abstinence Syndrome KW - Odds Ratio KW - Opiate Substitution Treatment KW - Opioid-Related Disorders KW - Pregnancy KW - Premature Birth KW - Retrospective Studies KW - Risk Factors KW - Smoking KW - Treatment Outcome AB - OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome. VL - 204 UR - http://www.sciencedirect.com/science/article/pii/S0002937810012639 IS - 2 ER - TY - JOUR T1 - Methadone and perinatal outcomes: a prospective cohort study JF - Addiction Y1 - 2012 A1 - Cleary, B A1 - Eogan, Maeve A1 - O'Connell, Michael P A1 - Fahey, T A1 - Gallagher, Paul J A1 - Clarke, Tom A1 - White, Martin J A1 - McDermott, Christine A1 - O'Sullivan, Anne A1 - Carmody, Deirdre A1 - Gleeson, Justin A1 - Murphy, Deirdre J KW - Methadone KW - Neonatal Abstinence Syndrome KW - Pregnancy KW - small-for-gestational age KW - withdrawal AB - AIMS:   Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose. DESIGN:   Prospective cohort study. SETTING:   Two tertiary care maternity hospitals. PARTICIPANTS:   A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010. MEASUREMENTS:   Information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included pre-term birth (<37 weeks' gestation), small-for-gestational-age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalization. FINDINGS:   Of the 114 liveborn infants 11 (9.6%) were born pre-term, 49 (42.9%) were small-for-gestational-age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%) were treated medically for NAS. Neonates exposed to methadone-only had a shorter hospitalization than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, P = 0.03). Neonates exposed to methadone doses ≥80 mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3 mg, P = 0.03). The incidence and duration of NAS did not differ between the two dosage groups. CONCLUSIONS:   The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization. VL - 107 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03844.x/abstract IS - 8 ER - TY - JOUR T1 - Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women JF - Pharmacoepidemiol Drug Saf Y1 - 2010 A1 - Cleary, B A1 - Butt, Hajeera A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J KW - Adult KW - Cohort Studies KW - Drug Utilization Review KW - Female KW - Fetal Development KW - Gestational Age KW - Humans KW - Pharmaceutical Preparations KW - Plant Preparations KW - Pregnancy KW - Pregnancy Complications KW - Prescription Drugs KW - Prevalence KW - Prospective Studies KW - Questionnaires KW - Street Drugs KW - United States KW - United States Food and Drug Administration KW - Young Adult AB - PURPOSE: To examine the extent, nature and determinants of medication use in early pregnancy. METHODS: We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). RESULTS: Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). CONCLUSIONS: Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders. VL - 19 UR - http://onlinelibrary.wiley.com/doi/10.1002/pds.1906/abstract IS - 4 ER - TY - Generic T1 - Medication use in early pregnancy - prevalence, appropriateness and prescribing for chronic medical disorders in a prospective cohort of women. 12th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 27 Y1 - 2009 A1 - Cleary, B A1 - Butt, Hajeera A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J UR - http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/Early%20pregnancy%20medication%20use.pdf ER - TY - Generic T1 - Methadone and Perinatal Outcomes: a Retrospective Cohort Study. Joint Schools of Pharmacy Research Day, 29th March 2010, School of Pharmacy, Queen’s University Belfast Y1 - 2010 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - White, Martin J A1 - Fahey, T A1 - Murphy, Deirdre J UR - http://www.hrbcentreprimarycare.ie/ppt/JointSchoolsResearchSeminar%20Presentation180310.ppt ER - TY - Generic T1 - Methadone and Perinatal Outcomes: a Retrospective Cohort Study. 26th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 19-22 August 2010, ICPE, Brighton, UK Y1 - 2010 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - White, Martin J A1 - Fahey, T A1 - Murphy, Deirdre J UR - http://www.hrbcentreprimarycare.ie/ppt/Cleary%20ISPE%202010.pptx ER - TY - Generic T1 - Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women. Friends of the Coombe Research Symposium, December 2008, Dublin Y1 - 2008 A1 - Cleary, B A1 - Strawbridge, Judith D A1 - Butt, Hajeera A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J UR - http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/CWIUH%20Research%20Symposium.ppt ER - TY - Generic T1 - Medication use in early pregnancy – prevalence, appropriateness and prescribing for chronic medical disorders in a prospective cohort of women. 12th ASM, AUDGPI, 27th February, RCSI, Dublin Y1 - 2009 A1 - Cleary, B A1 - Butt, Hajeera A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J UR - http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/Early%20pregnancy%20medication%20use.pdf ER -