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Narcotic tapering in pregnancy using long-acting morphine: an 18-month prospective cohort study in northwestern
Objective:
To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy.
Design:
A prospective cohort study over 18 months.
Setting:
Northwestern Ontario.
Participants:
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.
Intervention:
Narcotic replacement and tapering of narcotic use with long-acting morphine preparations.
Main Outcome Measures:
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.
Conclusion:
In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.