title: Narcotic tapering in pregnancy using long-acting morphine: an 18-month prospective cohort study in northwestern Ontario.
abstract: OBJECTIVE
  To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy.
  
  
  METHODS
  A prospective cohort study over 18 months.
  
  
  METHODS
  Northwestern Ontario.
  
  
  METHODS
  All 600 births at Meno Ya Win Health Centre in Sioux Lookout, Ont, from January 1, 2012, to June 30, 2013, including 166 narcotic-exposed pregnancies.
  
  
  METHODS
  Narcotic replacement and tapering of narcotic use with long-acting morphine preparations.
  
  
  METHODS
  Prenatal management of maternal narcotic use, incidence of neonatal abstinence syndrome, and other neonatal outcomes.
  
  
  RESULTS
  The incidence of neonatal abstinence syndrome fell significantly to 18.1% of pregnancies exposed to narcotics (from 29.5% in a previous 2010 study, P = .003) among patients using narcotic replacement and tapering with long-acting morphine preparations. Neonatal outcomes were otherwise equivalent to those of the nonexposed pregnancies.
  
  
  CONCLUSIONS
  In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.
authors.forename: Roisin
authors.initials: R
authors.lastname: Dooley
authors.forename: Joe
authors.initials: J
authors.lastname: Dooley
authors.forename: Irwin
authors.initials: I
authors.lastname: Antone
authors.forename: John
authors.initials: J
authors.lastname: Guilfoyle
authors.forename: Lianne
authors.initials: L
authors.lastname: Gerber-Finn
authors.forename: Kara
authors.initials: K
authors.lastname: Kakekagumick
authors.forename: Helen
authors.initials: H
authors.lastname: Cromarty
authors.forename: Wilma
authors.initials: W
authors.lastname: Hopman
authors.forename: Jill
authors.initials: J
authors.lastname: Muileboom
authors.forename: Nicole
authors.initials: N
authors.lastname: Brunton
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000328:Adult; D003692:Delayed-Action Preparations / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008431:Maternal-Fetal Exchange / Q000187:drug effects*; D009020:Morphine / Q000008:administration & dosage* / Q000633:toxicity; D009294:Narcotics / Q000008:administration & dosage* / Q000633:toxicity; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology* / Q000209:etiology; D009864:Ontario / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D009294:Narcotics; D009020:Morphine
references.citation: Addiction. 1999 Feb;94(2):231-9
references.pmid: 10396791
references.citation: Can J Rural Med. 2009 Spring;14(2):75-9
references.pmid: 19379632
references.citation: J Matern Fetal Neonatal Med. 2012 Feb;25(2):109-12
references.pmid: 21867403
references.citation: Can Fam Physician. 2011 Nov;57(11):e430-5
references.pmid: 22084472
references.citation: Can Fam Physician. 2011 Nov;57(11):e441-7
references.pmid: 22084474
references.citation: Eur Addict Res. 2012;18(3):130-9
references.pmid: 22354163
references.citation: J Popul Ther Clin Pharmacol. 2012;19(3):e488-506
references.pmid: 23241498
references.citation: Am J Obstet Gynecol. 2013 Sep;209(3):267.e1-5
references.pmid: 23727040
references.citation: Cochrane Database Syst Rev. 2013 Jun 05;(6):CD009879
references.pmid: 23740540
references.citation: Can Fam Physician. 2014 Oct;60(10):e493-8
references.pmid: 25316764
references.citation: Can Fam Physician. 2015 Feb;61(2):160-5
references.pmid: 25821874