Cigarette smoking in opioid-dependent pregnant women: Neonatal and maternal outcomes

Background: The relationship between cigarette smoking and neonatal and maternal clinical outcomes among opioid-agonist-treated pregnant patients is sparse. Objectives: (1) Is smoking measured at study entry related to neonatal and maternal outcomes in pregnant women receiving opioid-agonist medication? (2) Is it more informative to use a multi-item measure of smoking dependence or a single-item measure of daily smoking? (3) Is the relationship between smoking at study entry and outcomes different between methadone and buprenorphine? Methods: Secondary analyses examined the ability of the tobacco dependence screener (TDS) and self-reported past 30-day daily average number of cigarettes smoked, both measured at study entry, to predict 12 neonatal and 9 maternal outcomes in 131 opioid-agonist-maintained pregnant participants. Results: Past 30-day daily average number of cigarettes smoked was significantly positively associated with total amount of morphine (mg) needed to treat neonatal abstinence syndrome (NAS), Adjusted Odds Ratio (AOR) = 1.06 (95% CI: 1.02, 1.09), number of days medicated for NAS, AOR=1.04(95% CI: 1.01, 1.06), neonatal length of hospital stay in days, AOR=1.03 (95% Cl: 1.01, 1.05), and negatively associated with 1-AOR=.995 (95% CI:.991,.999) and 5-min Apgar scores, AOR=.996 (95% CI:.994,.998). Simple effect tests of the two significant TDS x medication condition effects found TDS was unrelated to non-normal presentation and amount of voucher money earned in the methadone [AORs=.90 (95% CI:.74, 1.08, p > .24) and 1.0(95% CI:.97, 1.03, p > .9)] but significant in the buprenorphine condition [AORs=1.57(95% Cl: 1.01, 2.45, p < .05) and 1.08 (95% CI: 1.04, 1.12, p < .01)]. Conclusions: Regardless of prenatal methadone or buprenorphine exposure, heavier cigarette smoking was associated with more compromised birth outcomes. (C) 2012 Elsevier Ireland Ltd. All rights reserved.