PQCNC - In the literature

March 2, 2022

In the literature...

ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015 - clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care.

Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome - In this review, studies evaluating the effects of breastfeeding, professional organizations’ proto- cols and recommendations regarding breastfeeding, and barriers to breastfeeding infants with NAS are discussed, as well as the dangers of illicit drug exposure and avoiding rebound NAS in a breastfed infant. Clinicians can play an important role in in identifying, supporting, counseling, and advocating for mothers who wish to breastfeed their infant with NAS.

Disparities in Breastfeeding Outcomes Among Women with Opioid Use Disorder - This study indicates a persistent disparity in breastfeeding outcomes in women with OUD (81.6% initiate and 23% at 6 months) relative to controls (97% initiate and 53% at 6 months), consistent with prior reports (5). However, the percentage of women who initiate breastfeeding in this Baby Friendly® hospital nearly meets (OUD group) or exceeds (abstaining controls) the national Healthy People 2020 target of 81.9%. This success rate may be related to the Baby Friendly® designation, emerging acceptance of breastfeeding in women with OUD, and the high representation of Hispanic women (~60%). However, breastfeeding rates at 6 months postpartum fall short of the Healthy People 2020 target of 60%, with a larger deficit among women with OUD. This emphasizes the need for breastfeeding support beyond the hospital stay with targeted support for women with OUD.

Breastfeeding among Mothers on Opioid Maintenance Treatment: A Literature Review - review interventions to improve breastfeeding outcomes among mothers on OMT to make recommendations for practice and future research.

Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome - Understanding the benefits of breastfeeding for opioid-dependent pregnant women and their neonates will enable clinicians to safely recommend breastfeeding for long-term health of these high-risk women and their infants. This review of the effects of in-utero exposure to opioids on infant development can assist clinicians to more effectively support opioid-dependent women to breastfeed their infants.

The Joys and Frustrations of Breastfeeding and Rooming-In Among Mothers With Opioid Use Disorder: A Qualitative Study - Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers’ autonomy in caring for their infants, minimizing stigma, and maximizing resilience

Breastfeeding and the substance-exposed mother and baby - Women with a substance use disorder received either standard Baby Friendly Initiative care only or were given additional support which included a dedicated breastfeeding support worker; personalised capacity building approach and a low stimuli environment for 5 days. Feasibility outcome measures were maternal recruitment, satisfaction and acceptability of support; breastfeeding on 5th postnatal day and severity of neonatal abstinence syndrome. Intervention participants demonstrated higher rates of continued breastfeeding and reported a greater degree of satisfaction with support and confidence in their breastfeeding ability. Maternal experience of health care practices, attitudes and postnatal environment influenced their perceptions of breastfeeding support. Breastfed infants were less likely to require pharmacotherapy for neonatal withdrawal and had a shorter hospital stay.

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice - Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy.

Obstetric management of women with opioid use disorder - Pregnancy presents a window of opportunity for effecting positive change in the lives of women with opioid use disorder (OUD). Care should be empathetic and nonjudgmental with a focus on counseling for initiation and maintenance of beneficial health behaviors hrough breastfeeding education and ante- natal discussion of contraception. Women will also benefit from anticipatory guidance with regard to neonatal abstinence syndrome

Opioid Use in Breastfeeding Mothers and Neonatal Risks - This perspective provides insight on management of opioids in breastfeeding mothers while safeguarding the infant.

A retrospective cohort study examining the utility of perinatal urine toxicology testing to guide breastfeeding initiation - In women with OUD prenatal UDT results alone are insufficient to guide breastfeeding decisions.

Revision of Breastfeeding Guidelines in the Setting of Maternal Opioid Use Disorder: One Institution’s Experience - The aims of our new guidelines are (a) to safely promote breastfeeding in all mothers with opioid use disorder who are in recovery, (b) to improve NAS outcomes through use of breastfeeding as a key nonpharmacologic treatment modality, and (c) to improve staff communication and consistency on the subject of breastfeeding in this patient population.

Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome - Qualitative analysis favored rooming-in over NICU care for increasing breastfeeding rates and discharge home in familial custody. Rooming-in was not associated with higher rates of readmission or in-hospital adverse events.

The Right to Mother’s Milk: A Call for Social Justice That Encourages Breastfeeding for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder - Inequitable access to mother’s milk represents a social injustice with the potential to negatively impact the health and well-being of future generations. Mother’s milk is globally accepted as the optimal source of infant nutrition, yet breastfeeding initiation and duration rates among minority populations (e.g., women with opioid use disorders [OUDs]) continue to lag those of the general population

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Keith M Cochran

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