title: Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: a systematic review.
abstract: Smoking is associated with adverse effects on pregnancy and fetal development, yet 88-95% of pregnant women in medication-assisted treatment for an opioid use disorder smoke cigarettes. This review summarizes existing knowledge about smoking cessation treatments for pregnant women on buprenorphine or methadone, the two forms of medication-assisted treatment for opioid use disorder indicated for prenatal use. We performed a systematic review of the literature using indexed terms and key words to capture the concepts of smoking, pregnancy, and opioid substitution and found that only three studies met search criteria. Contingency management, an incentive based treatment, was the most promising intervention: 31% of participants achieved abstinence within the 12-week study period, compared to 0% in a non-contingent behavior incentive group and a group receiving usual care. Two studies of brief behavioral interventions resulted in reductions in smoking but not cessation. Given the growing number of pregnant women in medication-assisted treatment for an opioid use disorder and the negative consequences of smoking on pregnancy, further research is needed to develop and test effective cessation strategies for this group.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA. Electronic address: sarah.c.akerman@dartmouth.edu.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Akerman
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA.
authors.forename: Alan I
authors.initials: AI
authors.lastname: Green
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, USA.
authors.forename: Daisy J
authors.initials: DJ
authors.lastname: Goodman
authors.affiliation: Biomedical Libraries, Geisel School of Medicine at Dartmouth, Hanover NH, 03755, USA.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Blunt
authors.affiliation: Vermont Center on Behavior and Health, Department of Psychiatry and Department of Psychology, University of Vermont, Burlington, VT, 05401, USA.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: 5 As; Cigarette smoking; Contingency management; Incentives; Motivational enhancement; Opioid; Pregnancy