Pregnancy and neonatal characteristics of opioid-dependent Indigenous Australians: a rural and metropolitan comparison.
OBJECTIVE
To identify maternal, obstetric and neonatal characteristics of opioid-dependent Indigenous Australians in rural and metropolitan settings.


METHODS
Retrospective cohort study of 232 metropolitan and 67 rural infants born to mothers maintained on methadone throughout pregnancy for the treatment of opiate dependency, between January 2000 and December 2006. Medical records of identified mother/infant dyads were reviewed by evaluating 20 different maternal, obstetric and neonatal parameters.


RESULTS
The number of infants of opiate-dependent mothers (IODMs) identified to be of Aboriginal ethnicity was 47 in the rural and 50 in the metropolitan setting. This reflected a significantly higher proportion in the rural versus metropolitan areas (70.1% vs 21.6%, P < 0.05). The effect of rurality was independent of ethnicity with significantly lower rates of neonatal withdrawal requiring treatment (P < 0.001), antenatal consultations (P < 0.01), department of community services (DoCS) involvement (P < 0.001) and shorter infant lengths of stay (P < 0.001). There was a non-significant trend towards more intrauterine growth restriction in Aboriginal infants. There were no significant differences in parameters in rural Indigenous versus rural non-Indigenous infants.


CONCLUSIONS
Significant differences exist between rural and metropolitan IODMs in terms of less attendance at antenatal consultations, less neonatal withdrawal requiring treatment, shorter average length of hospital stay for the infant and less documented DoCS involvement. These differences maybe a reflection of a different diagnostic and management approach. Ethnicity had no major clinical impact in either the rural or the metropolitan settings. Future research comparing the long-term outcomes would be of interest.
Tetstall
Emma
E
Nepean Clinical School, Nepean Hospital, The University of Sydney, Penrith, New South Wales, Australia.
Liu
Anthony Jun Wing
AJ
An
Ethan Ikhyun
EI
Canalese
Joe
J
Nanan
Ralph
R
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects*; D009357:Neonatal Abstinence Syndrome / Q000208:ethnology*; D010349:Patient Compliance / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011295:Prenatal Care; D012189:Retrospective Studies; D012424:Rural Population; D019966:Substance-Related Disorders / Q000208:ethnology / Q000534:rehabilitation*; D014505:Urban Population; D055815:Young Adult
D000701:Analgesics, Opioid; D008691:Methadone