Lessons from Maternal Mortality Reviews. How Addiction Care Providers can help improve Outcomes for Pregnant, Postpartum, and Parenting people.

Background: Drug-related deaths, including accidental and intentional overdose and other drug-related causes, are among the leading causes of maternal mortality in the United States.

Analysis: Addiction care providers can contribute to efforts to decrease maternal mortality related to substance use disorder. In this report, we review current research to inform the care of pregnant and parenting people with substance use disorder (SUD) to address rising drug-related deaths.

Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People.

Introduction: As perinatal drug overdoses continue to rise, reliable approaches are needed to monitor overdose trends during pregnancy and postpartum. This analysis aimed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-9/10-CM codes for drug overdose events among people in the MATernaL and Infant clinical NetworK (MAT-LINK) with medication for opioid use disorder (MOUD) during pregnancy.

Methods: People included in this analysis had electronic health record (EHR) documentation of MOUD and a known pregnancy outcome from January 1, 2014 through August 31, 2021.

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms.

Background: Perinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies.

Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report.

Introduction: Perinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression.

Semiparametric sensitivity analysis: unmeasured confounding in observational studies.

Establishing cause-effect relationships from observational data often relies on untestable assumptions. It is crucial to know whether, and to what extent, the conclusions drawn from non-experimental studies are robust to potential unmeasured confounding. In this paper, we focus on the average causal effect (ACE) as our target of inference.

Prevention of postpartum methamphetamine use with micronized progesterone trial (PROMPT): A pilot randomized controlled trial protocol.

Background: While most pregnant individuals with methamphetamine use disorder (MUD) achieve abstinence, the postpartum period remains a vulnerable time for return to methamphetamine use (MU). Promising data from human and animal models, including three randomized controlled trials, suggest that micronized progesterone may prevent postpartum return to cocaine and nicotine use by reducing cravings. The primary objective of this study is to assess feasibility of enrollment and randomization of postpartum individuals with MUD to micronized progesterone to prevent return to MU.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol.

Background: Opioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days.

Maternal psychophysiology profiles: associations with prenatal opioid use, maternal emotion dysregulation, and newborn neurobehavior.

Background: Opioid use among pregnant women has more than quadrupled over the past 20 years; however, comorbid risk factors such as emotion dysregulation confound the developmental consequences of prenatal opioid use. Maternal respiratory sinus arrhythmia (RSA) may help to disentangle the comorbid risk factors of prenatal emotion dysregulation and substance use and isolate their consequences on newborn neurobehavior.

Methods: We examined maternal RSA in response to a mild, infant-related stress task in pregnant people (N = 192; 30 on medications for opioid use disorder) recruited from hospitals and a specialty prenatal clinic for substance use disorder.

Maternal mental health as a major contributor to maternal mortality.

Perinatal mental health conditions affect up to 20 % of pregnant or postpartum individuals, and nearly 15 % of pregnant individuals meet criteria for substance use disorder (SUD). All providers taking care of pregnant or postpartum individuals will encounter patients in these scenarios. Maternal Mortality Review Committees (MMRCs) have determined maternal mental health conditions, including SUD, to be the leading cause of preventable maternal death during pregnancy or in the first year postpartum.

Optimizing Opioid Prescription Quantity After Cesarean Delivery: A Randomized Controlled Trial.

Objective: To test whether an individualized opioid-prescription protocol (IOPP) with a shared decision-making component can be used without compromising postcesarean pain management.

Methods: In this multicenter randomized controlled noninferiority trial, we compared IOPP with shared decision making with a fixed quantity of opioid tablets at hospital discharge. We recruited at 31 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

Drug Testing Interpretation in the Peripartum Setting: Results of Clinician Survey.

Objectives: The objectives of this study were to (1) survey obstetrical and pediatric clinicians' experience, confidence, and training in maternal and neonatal drug testing interpretation; (2) determine their proficiency in drug test interpretation; and (3) assess predictors of correct interpretation.

Methods: We conducted a cross-sectional survey of clinicians caring for pregnant people or newborns at an urban academic center. We assessed clinicians' demographic characteristics, experience, confidence, and prior training in interpretation of maternal and newborn drug tests.

Naltrexone Compared With Buprenorphine or Methadone in Pregnancy: A Systematic Review.

Objective: Although naltrexone is an evidence-based medication for opioid use disorder (MOUD), few data are available with use in pregnancy. Our objective was to assess outcomes of pregnant individuals with opioid use disorder (OUD) taking naltrexone compared with those taking methadone or buprenorphine.

Data Sources: We undertook a systematic review using electronic database search (PubMed, CINAHL, EMBASE, PsycInfo), conference proceedings, and trial registries including ClinicalTrials.

Integrative whole-genome and transcriptome analysis of HER2-amplified metastatic breast cancer.

Background: In breast cancer, the advent of anti-HER2 therapies has made HER2+ tumors a highly relevant subgroup. However, the exact characteristics which prohibit clinical response to anti-HER2 therapies and drive disease progression are not yet fully known. Integrative whole-genome and transcriptomic sequencing data from both primary and metastatic HER2-positive breast cancer will enhance our understanding of underlying biological processes.

Kratom Use Among Pregnant and Lactating Individuals With Substance Use Disorder.

Objective: Kratom ( Mitragyna speciosa ) use in pregnancy is associated with maternal and neonatal opioid withdrawal syndrome. However, kratom use patterns in the population of peripartum and postpartum individuals with substance use disorder (SUD) are unknown. The aim of this study was to determine the proportion of pregnant and postpartum individuals with SUD who report using kratom in pregnancy or lactation and the reasons for their use.

Rotation-based schedules in elementary schools to prevent COVID-19 spread: a simulation study.

Rotations of schoolchildren were considered as a non-pharmacological intervention in the COVID-19 pandemic. This study investigates the impact of different rotation and testing schedules.We built an agent-based model of interactions among pupils and teachers based on a survey in an elementary school in Prague, Czechia.

Postpartum Extended-Release Buprenorphine Tissue Necrosis.

Background: Extended-release buprenorphine (XRB) may improve medication for opioid use disorder continuation among postpartum individuals. However, obstetric clinicians have relatively little experience with XRB. We describe two cases of XRB-related tissue necrosis in postpartum individuals to highlight recommended injection technique and management strategies for this rare complication.

Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial.

Background And Aims: Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC).

Design: This study was a pilot single-blinded multi-site randomized trial.

The Fall of Roe v. Wade : The Addiction Specialist's Role in Championing Reproductive Rights.

Reproductive age-pregnant individuals who use substances are disproportionately impacted by the US Supreme Court reversal of Roe v. Wade . Because of historic and ongoing discrimination against pregnant individuals who use substances, this group is at high risk for inadequate pregnancy options counseling and lack of access to safe and legal abortions.

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device.

Objective: To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)-cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management.