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as result of the ongoing opioid dilemm plaguing the nation, the American conference of Obstetricians and Gynecologists claimed Wednesday that an approach to dealing with babies born through addiction that was once thought to it is in harmful need to now be considered.

In 2012, an approximated 21,732 babies were born v neonatal abstinence syndrome, or NAS. It is a baby born addicted come opioids every 25 minutes, according to the national Institute on drug Abuse. And also as shortly as the child is the end of the womb, it starts detoxing from the drugs that were passed through the mom placenta. Follow to the march of Dimes, most frequently those drugs room opioids. Between 2000 and 2009 the variety of delivering mothers using or dependence on opioids increased virtually fivefold. It’s a harsh reality that is part of the opioid epidemic that has wreaked havoc across the nation.

traditional wisdom has actually been that preventing opioids or detoxing mothers throughout pregnancy was as well risky for the fetus and the mother, yet ACOG has actually taken an additional look at this practice in irradiate of the overdose crisis. Those dangers include stillbirth and also fetal stress.

Medically helped treatment, or MAT together it’s advert to, gradually weans someone that is addicted come opioids turn off the drugs they are using with the aid of other medications such together buprenorphine or methadone, in addition to behavioral therapy. This, too, is not without danger to the mother, or the unborn baby, who can at some point be born v NAS. However, MAT has actually been associated with improved prenatal care, lower rates the complications during pregnancy and higher rates the compliance to seeks treatment. Unequal MAT, medically oversaw withdrawal is the tapering turn off an opioid there is no the aid of a medication, however still coupled with the other support services.

Dr. Maria Mascola, that leads ACOG’s committee ~ above obstetric practice, claimed that if MAT stays the gold conventional to help a mother taper under her use of opioids, there to be some recognition that withdrawing through the aid of a physician and also other assistance services could be effective. “There is a farming body that claims it can be safe, but the data is tho limited,” stated Mascola.


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“For this come be successful it often requires prolonged inpatient care and also intensive outpatient behavioral health follow up,” claimed Dr. Note Turrentine, OB/GYN at Texas children’s Pavilion for Women. Turrentine was not affiliated with the committee’s decision.

Dr. Alfred Abuhamad, chairman of the society for Maternal Fetal Medicine, said, “If you have actually the resources and you have actually the support, and the specialization on the health treatment team, the psychosocial assistance … this is an option that no seem to be connected with complications together we thought in the past. That is an choice viable because that a pregnant mrs if she choose to execute so, yet it is really necessary to support those interventions.” Abuhamad is likewise not part of the committee.

assistance is key

Mascola agreed, pointing to studies reflecting high relapse rates varying from 59% to more than 90% in some instances – the difference in these cases being a absence of lengthy term followup. “If they relapse, it have the right to be dangerous … they might go back to illicit drug usage or overdose,” said Mascola.


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Dr. Craig Towers, that specializes in high-risk pregnancies at The university of Tennessee medical Center, says medically aided detoxing can be very successful. Towers has helped detox much more than 500 mothers. He was not involved in the committee’s decision-making. “I am glad come hear ACOG is recognizing the medically supervised withdrawal under the care of an experienced physician have the right to be offered to pregnant women with opioid usage disorder as an additional option beyond MAT (medically aided treatment). This technique is really successful when associated with behavior health and results in born who do not suffer from NAS,” stated Towers.

permanent outcomes the babies born with NAS are still unclear, even though it has been connected to poorer outcomes in school and increased threat of ADHD.

Still much more research needed

Mascola claimed the change in thinking was pushed both by patience conversations and new data looking at medically managed withdrawal the not only saw success because that the mothers, but likewise positive outcomes because that the infants. “There no really any data to support that and we wanted to adhere to what we knew,” stated Mascola, referring to stillbirth and fetal stress.

However, she cautioned the the data was minimal and there room still a the majority of questions around who this protocol may work for. “We’re still learning that, we would love to recognize who the is successful for. Those who perhaps don’t have easy access ? Those who are very motivated?” said Mascola.


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“Abstinence-based viewpoints don’t perform well for many patients … and also being pregnant doesn’t necessarily change that equation” said Dr. Andrew Kolodny, former chief medical officer the the Phoenix residence Foundation. Kolodny to be not affiliated in the committee’s decision yet pointed the end that pregnancy have the right to be a specifically stressful time because that women, that then are likewise dealing v addiction. He claimed that if this might be a good option for women v mild opioid addiction and dependency issues, he was doubtful about this approach for patients who were severely dependency on prescription painkillers or heroin.


however in locations where accessibility to buprenorphine or methadone are limited because the ease of access of the medicine is restricted to certain providers or clinics, Mascola states medically managed withdrawal can be an option. However, as Abuhamad questions, “If nothing have access to methadone or buprenorphine – will they have access to medically oversaw withdrawal?”