Substance Abuse During Pregnancy and Punitive Reporting Policies: What are the Effects on Neonatal Abstinence Syndrome Rates?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the changes in rates of opioid abuse disorder in pregnancy and neonatal abstinence syndrome 2. Discuss the authors conclusions regarding rates of neonatal abstinence syndrome before and after the enactment of punitive policies related to substance abuse in pregnancy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Opioid use disorder (OUD) has gone up more than 4 times among pregnant women. OUD can cause many negative health outcomes for mothers and their babies, both during pregnancy and after delivery. Infants can be born with breathing and feeding problems, and mothers are at risk of opioid-related overdoses. Prenatal opioid exposure has resulted in a 7-fold increase in neonatal abstinence syndrome (NAS) from 2000 to 2014.
Many states have enacted a range of policies intended to reduce opioid use in pregnancy, the proximal cause of most cases of NAS. The availability of treatment for women with substance use disorder including opioids has increased, but such programs are not always readily accessible. Many states have also enacted policies that potentially punish women by a considering substance use during pregnancy to be child abuse or neglect. As 2015, 25 states have these punitive policies and 23 states require health care professionals to report suspected prenatal drug abuse to child protective services or health officials. The question is whether there is any correlation between these punitive or reporting policies and NAS. Data are scant.
JAMA Network Open recently reported from that cross-sectional study of over 4 million births in 8 states. Policies that criminalized substance use during pregnancy, considered it grounds for civil commitment, or considered it child abuse or neglect were associated with significantly greater rates of NAS in the first full year after enactment and more than 1 full year after enactment. In contrast, policies that required reporting of suspected prenatal substance use were not associated with rates of NAS. Punitive policies that were intended to deter women from using substances during pregnancy actually deterred them from seeking prenatal care. Reporting policies did not significantly increase nor decrease NAS.
The authors did recognize limitations to their study. For example, there may be other policies associated with maternal opioid use that were not addressed in this study. However, based on the evidence, the authors conclude that punitive policies likely increase rather than decrease NAS. Furthermore, they recommend that policy makers follow the guidance of public health experts who believe that the focus should be on be primary prevention of opioid use disorder. Examples of such prevention policies include: (1) responsible opioid prescribing (2) preconception and antenatal physical and behavioral healthcare and (3) ensuring family planning access to women with OUD (as 9 out 10 pregnancies in this population group are unplanned).
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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