title: Maternal-Fetal Monitoring of Opioid-Exposed Pregnancies: Analysis of a Pilot Community-Based Protocol and Review of the Literature.
abstract: OBJECTIVE
  To describe/analyse a novel, community-based prenatal monitoring protocol for opioid-exposed pregnancies developed by our centre in 2014 to optimize prenatal care for this population. A literature review of published monitoring protocols for this population is also presented.
  
  
  METHODS
  Retrospective comparison of pre-protocol (n = 215) and post-protocol (n = 251) cohorts. Medline and Embase were searched between 2000-2016 using MeSH terms: [fetal monitoring OR prenatal care] AND [opioid-related disorders OR substance-related disorders] in Medline and [fetal monitoring OR prenatal care] AND [opiate addiction OR substance abuse] in Embase, producing 518 results. Thirteen studies included protocols for monitoring opioid-exposed pregnancies. No comprehensive monitoring protocols with high-quality supporting evidence were found.
  
  
  RESULTS
  We evaluated 466 opioid-exposed pregnancies, 215 before and 251 after introduction of the protocol. Since implementation, there was a significant increase in the number of opioid-exposed patients who have underwent urine drug screening (72.6% to 89.2%, P < 0.0001); a significant reduction in the number of urine drug screenings positive for illicit opioids (50.2% to 29.1%, P < 0.0001); and a significant increase in the number of patients who discontinued illicit opioid use by the time of delivery (24.7% to 39.4%, P < 0.01). There was no difference in the CS rate (27.4% vs. 26.3%, P > 0.05). There were no observed differences in the rate of preterm birth, birth weight <2500 g, or Apgar score <7 (P > 0.05).
  
  
  CONCLUSIONS
  Care of women with increased opioid use during pregnancy is an important but under-studied health issue. A novel protocol for focused antenatal care provision for women with opioid-exposed pregnancies improves standard of care and maternal/fetal outcomes.
authors.affiliation: Anishnaabe Bimaadiziwin Research Program, Sioux Lookout, ON.
authors.forename: Gareth
authors.initials: G
authors.lastname: Ryan
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.
authors.forename: Joe
authors.initials: J
authors.lastname: Dooley
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout, ON.
authors.forename: Megan
authors.initials: M
authors.lastname: Bollinger
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout, ON.
authors.forename: Lianne
authors.initials: L
authors.lastname: Gerber Finn
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON. Electronic address: lkelly@mcmaster.ca.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D009293:Opioid-Related Disorders; D011247:Pregnancy; D011248:Pregnancy Complications; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Opioid-related disorders; fetal monitoring; non-stress testing; pregnancy; ultrasonography