Cigarette smoking in opioid-dependent pregnant women: neonatal and maternal outcomes

Abstract

Background: The relationship between cigarette smoking and neonatal and maternal clinical outcomes among opioid-agonist-treated pregnant patients is sparse.

Objectives: (1) Is smoking measured at study entry related to neonatal and maternal outcomes in pregnant women receiving opioid-agonist medication? (2) Is it more informative to use a multi-item measure of smoking dependence or a single-item measure of daily smoking? (3) Is the relationship between smoking at study entry and outcomes different between methadone and buprenorphine?

Methods: Secondary analyses examined the ability of the tobacco dependence screener (TDS) and self-reported past 30-day daily average number of cigarettes smoked, both measured at study entry, to predict 12 neonatal and 9 maternal outcomes in 131 opioid-agonist-maintained pregnant participants.

Results: Past 30-day daily average number of cigarettes smoked was significantly positively associated with total amount of morphine (mg) needed to treat neonatal abstinence syndrome (NAS), Adjusted Odds Ratio (AOR)=1.06 (95% CI: 1.02, 1.09), number of days medicated for NAS, AOR=1.04 (95% CI: 1.01, 1.06), neonatal length of hospital stay in days, AOR=1.03 (95% CI: 1.01, 1.05), and negatively associated with 1-AOR=.995 (95% CI: .991,.999) and 5-min Apgar scores, AOR=.996 (95% CI: .994,.998). Simple effect tests of the two significant TDS×medication condition effects found TDS was unrelated to non-normal presentation and amount of voucher money earned in the methadone [AORs=.90 (95% CI: .74, 1.08, p>.24) and 1.0 (95% CI: .97, 1.03, p>.9)] but significant in the buprenorphine condition [AORs=1.57 (95% CI: 1.01, 2.45, p<.05) and 1.08 (95% CI: 1.04, 1.12, p<.01)].

Conclusions: Regardless of prenatal methadone or buprenorphine exposure, heavier cigarette smoking was associated with more compromised birth outcomes.

Trial registration: ClinicalTrials.gov NCT00271219.

Keywords: Agonist treatment; Neonatal abstinence syndrome; Neonate; Opioid dependence; Pregnancy; Smoking.

Conflict of interest statement

Conflict of Interest

H.E.J. discloses that she has received reimbursement for time and travel from Reckitt Benckiser. K.E.O’G. discloses that he has received reimbursement for time from Reckitt Benckiser. The remaining authors report no conflicts of interest.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1. Bar Charts of Neonatal Outcome Measures at Selected Values of Past 30-Day Average Number of Cigarettes Smoked

Poisson regression analyses were used to test the relationship between these 5 outcome variables and the past-30 day daily average number of cigarettes smoked, adjusting for medication condition, site, and estimated gestational age at study entry. Estimates are exponentiated parameter estimates. Estimates were calculated at 4 values of the predictor variable of past-30 day daily average number of cigarettes smoked: No cigarette smoking; below-average cigarette smoking, defined as 5.88 cigarettes/day (−1 SD); average cigarette smoking, defined as 13.66 cigarettes/day (Mean); and, above-average cigarette smoking, defined as 21.44 cigarettes/day (+1 SD).