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Your search keyword '"Shrestha, Hira"' showing total 3 results
Start Over Author "Shrestha, Hira" Topic buprenorphine
3 results on '"Shrestha, Hira"'

1. Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects.

Author

Wachman EM, Saia K, Miller M, Valle E, Shrestha H, Carter G, Werler M, and Jones H

Subjects
Adult, Female, Humans, Infant, Newborn, Opiate Substitution Treatment, Pilot Projects, Pregnancy, Pregnancy Complications prevention & control, Pregnancy Outcome, Retrospective Studies, Treatment Outcome, Analgesics, Opioid therapeutic use, Buprenorphine therapeutic use, Naltrexone therapeutic use, Narcotic Antagonists therapeutic use, Opioid-Related Disorders drug therapy
Abstract

Purpose: The use of the opioid antagonist naltrexone (NTX) for pregnant women with opioid use disorder (OUD) remains understudied. The purpose of this pilot study was to examine pregnancy and neonatal outcomes in a cohort of NTX-treated women., Methods: This single-center, retrospective cohort study included 6 mother-infant dyads taking NTX compared with 13 taking buprenorphine (BUP) between 2017 and 2019. Maternal demographic characteristics, any unprescribed or illicit opioid use per urine toxicology or provider report during the pregnancy or 6 months' postdelivery, delivery outcomes, gestational age, birth weight, Apgar scores, neonatal intensive care unit admission, and neonatal abstinence syndrome (NAS) outcomes (NAS diagnosis, pharmacologic treatment, and total hospital length of stay) were compared., Findings: Maternal and infant demographic characteristics were similar between the 2 groups, with the exception of cigarette smoking in the BUP group being more common (92% vs 33%; P = 0.02). None of the women on NTX versus 23% of the women on BUP had documented opioid misuse (P = 0.52). No infants in the NTX group had a NAS diagnosis versus 92% in the BUP group (P < 0.001). Forty-six percent of the BUP-exposed infants were treated for NAS versus 0% in the NTX group (P < 0.001). NTX-exposed infants had a shorter length of stay (mean [SD], 3.2 [1.6] vs 10.9 [8.2] days; P = 0.008)., Implications: Maintaining women on NTX during pregnancy was associated with favorable outcomes. These results support the need for larger multicenter studies sufficiently powered to detect possible differences between the medications on long-term maternal and child safety and efficacy outcomes., (Copyright © 2019. Published by Elsevier Inc.)

Published
2019
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2. Medication for Opioid Use Disorder During Pregnancy -- Maternal and Infant Network to Understand Outcomes Associated with Use of Medication for Opioid Use Disorder During Pregnancy (MAT-LINK), 2014-2021.

Author

Miele, Kathryn, Kim, Shin Y., Jones, Rachelle, Rembert, Juneka H., Wachman, Elisha M., Shrestha, Hira, Henninger, Michelle L., Kimes, Teresa M., Schneider, Patrick D., Sivaloganathan, Vaseekaran, Sward, Katherine A., Deshmukh, Vikrant G., Sanjuan, Pilar M., Maxwell, Jessie R., Seligman, Neil S., Caveglia, Sarah, Louis, Judette M., Wright, Tanner, Bennett, Carolyne Cody, and Green, Caitlin

Subjects
METHADONE treatment programs, NARCOTICS, PUBLIC health surveillance, NALTREXONE, SUBSTANCE abuse, SUBSTANCE abuse in pregnancy, BUPRENORPHINE, AGE distribution, RACE, POPULATION geography, PREGNANCY outcomes, NALOXONE, HEALTH insurance, DESCRIPTIVE statistics, SOCIODEMOGRAPHIC factors, PREGNANCY
Abstract

Problem: Medication for opioid use disorder (MOUD) is recommended for persons with opioid use disorder (OUD) during pregnancy. However, knowledge gaps exist about best practices for management of OUD during pregnancy and these data are needed to guide clinical care. Period Covered: 2014--2021. Description of the System: Established in 2019, the Maternal and Infant Network to Understand Outcomes Associated with Medication for Opioid Use Disorder During Pregnancy (MAT-LINK) is a surveillance network of seven clinical sites in the United States. Boston Medical Center, Kaiser Permanente Northwest, The Ohio State University, and the University of Utah were the initial clinical sites in 2019. In 2021, three clinical sites were added to the network (the University of New Mexico, the University of Rochester, and the University of South Florida). Persons receiving care at the seven clinical sites are diverse in terms of geography, urbanicity, race and ethnicity, insurance coverage, and type of MOUD received. The goal of MAT-LINK is to capture demographic and clinical information about persons with OUD during pregnancy to better understand the effect of MOUD on outcomes and, ultimately, provide information for clinical care and public health interventions for this population. MAT-LINK maintains strict confidentiality through robust information technology architecture. MAT-LINK surveillance methods, population characteristics, and evaluation findings are described in this inaugural surveillance report. This report is the first to describe the system, presenting detailed information on funding, structure, data elements, and methods as well as findings from a surveillance evaluation. The findings presented in this report are limited to selected demographic characteristics of pregnant persons overall and by MOUD treatment status. Clinical and outcome data are not included because data collection and cleaning have not been completed; initial analyses of clinical and outcome data will begin in 2023. Results: The MAT-LINK surveillance network gathered data on 5,541 reported pregnancies with a known pregnancy outcome during 2014--2021 among persons with OUD from seven clinical sites. The mean maternal age was 29.7 (SD = ±5.1) years. By race and ethnicity, 86.3% of pregnant persons were identified as White, 25.4% as Hispanic or Latino, and 5.8% as Black or African American. Among pregnant persons, 81.6% had public insurance, and 84.4% lived in urban areas. Compared with persons not receiving MOUD during pregnancy, those receiving MOUD during pregnancy were more likely to be older and White and to have public insurance. The evaluation of the surveillance system found that the initial four clinical sites were not representative of demographics of the South or Southwest regions of the United States and had low representation from certain racial and ethnic groups compared with the overall U.S. population; however, the addition of three clinical sites in 2021 made the surveillance network more representative. Automated extraction and processing improved the speed of data collection and analysis. The ability to add new clinical sites and variables demonstrated the flexibility of MAT-LINK. Interpretation: MAT-LINK is the first surveillance system to collect comprehensive, longitudinal data on pregnant person--infant dyads with perinatal outcomes associated with MOUD during pregnancy from multiple clinical sites. Analyses of clinical site data demonstrated different sociodemographic characteristics between the MOUD and non-MOUD treatment groups. Public Health Actions: MAT-LINK is a timely and flexible surveillance system with data on approximately 5,500 pregnancies. Ongoing data collection and analyses of these data will provide information to support clinical and public health guidance to improve health outcomes among pregnant persons with OUD and their children. [ABSTRACT FROM AUTHOR]

Published
2023
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3. Neurobehavioral outcomes of infants exposed to buprenorphine-naloxone compared with naltrexone during pregnancy.

Author

Mantri, Saaz, Cheng, An-Chiao, Saia, Kelley, Shrestha, Hira, Amgott, Rachel, Bressler, Jonathan, Werler, Martha M., Carter, Ginny, Jones, Hendree E., and Wachman, Elisha M.

Subjects
*BUPRENORPHINE, *ALKALOIDS, *NALOXONE, *ALCOHOLISM, *NALTREXONE, *PREGNANT women, *INFANTS, *OPIOID abuse
Abstract

Naltrexone is a medication used to treat both opioid and alcohol use disorder with limited experience in pregnant individuals, particularly in comparison to more commonly utilized treatments such as buprenorphine-naloxone. The long-term outcomes of infants exposed to naltrexone has not been previously examined. To compare the neurobehavioral outcomes of naltrexone versus buprenorphine-naloxone exposed infants. Multi-centered prospective cohort study. Pregnant people on prescribed buprenorphine-naloxone or naltrexone were enrolled during pregnancy and the dyad followed until 12 months after delivery. Infants were evaluated at 4–6 weeks corrected gestational age (CGA) using the NICU Neonatal Neurobehavioral Scale (NNNS) and at the 12-month CGA visit using the Ages and Stages Questionnaire, Third Edition (ASQ-3). There were 7 dyads in the naltrexone group and 34 in the buprenorphine-naloxone group. On the NNNS, infants exposed to naltrexone had higher median scores for arousal and excitability, and lower median scores for attention and regulation at 4–6 weeks CGA compared to the buprenorphine-naloxone group. None of the infants in the naltrexone group were monitored for NOWS and had shorter length of hospital stay compared with the buprenorphine-naloxone group. Although no statistically significant differences were observed, more infants in the buprenorphine-naloxone group were identified as at risk for development delays in the communication, problem solving, and personal social domains of the ASQ-3 at 12 months CGA. Results should be interpreted with caution given this study's small sample size and lack of a prospective comparison cohort. In this small cohort, there are differences noted in infant neurobehavior by NNNS at 4–6 weeks of age when comparing the buprenorphine-naloxone and naltrexone groups. At 12 months, ASQ-3 scores were similar but with percentage differences in potential development delay risk observed between the two groups. Larger cohort studies are needed to determine the long-term child outcomes after naltrexone exposure in pregnancy. • Neurobehavior of infants exposed to naltrexone vs buprenorphine-naloxone were compared. • Infants exposed to naltrexone demonstrated differences in neurobehavior at 4–6 weeks. • Infants in the naltrexone group had shorter hospitalizations with no NOWS diagnoses. [ABSTRACT FROM AUTHOR]

Published
2024
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