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Cook B, Shadowen C, Clark L, Hoover A, Lee S, Bender W. Genital VZV in a Third Trimester Pregnancy and the Critical Role of Interdisciplinary Planning. Case Rep Infect Dis 2024; 2024:1937661. [PMID: 38715575 PMCID: PMC11074869 DOI: 10.1155/2024/1937661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Herpes simplex (HSV) and varicella zoster (VZV) viruses are harmful infectious agents in pregnancy due to their ability to impact maternal-fetal dyads through various modalities including vertical transmission, neonatal infection, and maternal morbidity. As a result, accurate diagnosis and prompt treatment of these infections in pregnancy is critical. Case A 19-year-old primigravida presented to our tertiary care center at 30 weeks' gestation with vulvar swelling, burning, and pain. Workup included direct PCR testing of a particularly erythematous area of the vulva which returned positive for VZV. The patient was treated with a 10-day course of acyclovir with resolution of her symptoms. She later had a full-term spontaneous vaginal delivery outside of the infectious window with no significant morbidity for either her or her neonate. Conclusion Although a rare presentation, the presence of a genital lesion or labial swelling during pregnancy warrants workup for VZV, particularly among patients known to be varicella nonimmune. If genital VZV is diagnosed during pregnancy, the development of contingency plans through interdisciplinary collaboration should be pursued to ensure a safe delivery and postpartum course for both the maternal-fetal dyad as well as other patients on the unit and the provider care team.
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Affiliation(s)
- Brenna Cook
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline Shadowen
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lorna Clark
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alena Hoover
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Lee
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Whitney Bender
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Maternal Fetal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Nguyen A, Shadowen H, Shadowen C, Thakkar B, Knittel AK, Martin CE. Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy. Front Psychiatry 2023; 14:1157611. [PMID: 37124262 PMCID: PMC10133465 DOI: 10.3389/fpsyt.2023.1157611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation. Methods This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status. Results Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02). Conclusion In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.
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Affiliation(s)
- Andrea Nguyen
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Hannah Shadowen
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Caroline Shadowen
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Bhushan Thakkar
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Caitlin E. Martin,
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Shadowen C, Jallo N, Parlier-Ahmad AB, Brown L, Kinser P, Svikis D, Martin CE. What Recovery Means to Postpartum Women in Treatment for Opioid Use Disorder. Womens Health Rep (New Rochelle) 2022; 3:93-103. [PMID: 35136881 PMCID: PMC8812494 DOI: 10.1089/whr.2021.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
Introduction: Opioid overdose has become a leading cause of pregnancy-associated deaths, particularly in the 1st year postpartum, highlighting the need to better understand how to promote recovery for postpartum women. This mixed-methods study aims to investigate how postpartum women receiving medication for opioid use disorder (MOUD) define recovery and factors associated with recovery progression or inhibition. Methods: Women receiving MOUD 2-6 months postpartum were recruited from an outpatient perinatal addiction clinic. Participants completed electronic measures including the Brief Assessment of Recovery Capital (BARC-10, total score range: 6-60) and semistructured individual interviews. Substance Abuse and Mental Health Services Administration (SAMHSA)'s recovery framework served as the conceptual model for interview guide development. Descriptive statistics were generated for survey responses. A qualitative descriptive approach was used to analyze and report the interview data. Results: On average, participants (n = 8) were 28.6 years old and taking 19.5 mg/day buprenorphine (range 8-24). Fifty percent identified as white and 37.5% as black. All participants identified as currently in recovery, with mean BARC-10 score 52.5 (standard deviation 4.8). Recovery goals included no use of drugs or alcohol (62.5%), being a better partner/spouse (87.5%), and improving finances (87.5%). Interviews generated themes including recovery as transformative, building resilience, and transforming one's health, relationships, and environment through recovery. Conclusions: Participants defined recovery as a dynamic transformative process, including nonabstinence-based goals consistent with SAMHSA domains coupled with reduced substance use. Central to recovery for our postpartum participants was the sense of self reinforced throughout their recovery journey. Women highlighted the key role of MOUD in their recovery process. Findings underscore the need for individualized treatment for postpartum women with opioid use disorder based on their personal goals and will inform development of a validated, gender-informed measure of patient-reported recovery outcomes tailored for this population.
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Affiliation(s)
- Caroline Shadowen
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy Jallo
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anna Beth Parlier-Ahmad
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lisa Brown
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia Kinser
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace Svikis
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E Martin
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Abstract
OBJECTIVES For women with opioid use disorder (OUD), the postpartum period is an especially vulnerable period. Buprenorphine (BUP) improves OUD outcomes during this timeframe. Once-monthly injectable BUP (XRI-BUP) is a newer formulation for which evidence of use in postpartum women is extremely limited. We present a case series of 9 women who transitioned from sublingual (SL-BUP) to XRI-BUP in their first year postpartum. METHODS We conducted a retrospective chart review of our institution's medical record for patients who received at least one administration of XRI-BUP in their first year postpartum (January 2017-March 2020). Data were collected from baseline through mean follow-up of 281.4 days (range 235-417) for participant outcomes. RESULTS The most common indications for initiating XRI-BUP were participant preference (n = 9) followed by challenges taking SL-BUP (n = 6). Four of the 9 participants transitioned back from XRI- to SL-BUP during the study timeframe, for reasons including incarceration and undesired side effects. Preliminary treatment outcomes demonstrated that participants remained on SL- (n = 4) or XRI-BUP (n = 5) through follow-up. The 5 participants who remained on XRI-BUP had consistent negative urine drug tests for nonprescribed opioids during the study period. CONCLUSIONS To our knowledge, this is the first study that reviews the feasibility of using XRI-BUP in postpartum women. Our results suggest that XRI-BUP is a viable treatment option, which should be further investigated in future studies of postpartum women with OUD.
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Affiliation(s)
| | - F. Gerard Moeller
- Virginia Commonwealth University School of Medicine
- Department of Psychiatry
- Institute for Drug and Alcohol Studies
| | - Caitlin E. Martin
- Virginia Commonwealth University School of Medicine
- Institute for Drug and Alcohol Studies
- Department of Obstetrics and Gynecology
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Shadowen C, Wheeler R, Terplan M. Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy. Addict Sci Clin Pract 2021; 16:22. [PMID: 33781326 PMCID: PMC8008637 DOI: 10.1186/s13722-021-00228-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of medical conditions and their evidence-based medications varies among individuals. This range of knowledge may affect attitudes and influence medical decision-making of both patients and providers. Perceptions may be even more impactful in pregnancy, a timeframe subject to bias, and in diseases that include behavioral symptoms and often carry significant societal stigma, such as opioid use disorder (OUD). We present our findings from a survey assessing participants' knowledge of three distinct medical conditions (diabetes mellitus, bipolar disorder, and OUD) and how this knowledge affects perceptions of these disease states during pregnancy. METHODS Using existing surveys in the literature as a guideline, we designed a cross-sectional survey including multiple-choice questions to evaluate our hypothesis that less knowledge about a medical condition would result in more negative opinions towards that condition and its treatment throughout pregnancy. Participants responded to perception statements using a 5-point Likert scale (1 = "strongly disagree," 5 = "strongly agree"). Surveys were administered to patients in prenatal care, patients in OUD treatment, medical students, and medical residents within a single institution. Response means were generated and compared using t tests and ANOVA. RESULTS A total of 323 participants completed the survey. There were differences in knowledge between respondent groups and by disease state, with prenatal patients having the least knowledge of all groups about OUD diagnosis (88.5% of prenatal patients answered correctly) and its treatment (91.8% answered correctly). Overall Likert means of all responses demonstrated that participants agreed that new mothers with OUD (mean 4.27, 5 = "strongly agree") and their babies (4.12) would have challenges that others would not, compared to mothers with bipolar disorder (4.03) and their babies (3.60) as well as mothers with diabetes (3.87) and their babies (3.47), p < .001. Overall, respondents were likely to agree that women with OUD should not try to get pregnant (3.47), whereas they overall disagreed with that statement when it pertained to women with bipolar disorder (2.69, 2 = "disagree") or diabetes (2.12), p = 0.03. CONCLUSIONS With this single-center study, we found that, though there were gaps in knowledge regarding disease and disease treatment during pregnancy, less knowledge was not associated with more negative perceptions of disease and disease treatment during pregnancy. Perceptions were especially negative toward pregnant women with OUD. Increasing awareness of lived experiences of patients with disease, as well as the biases carried by both patients and providers, could improve treatment of chronic diseases and outcomes for patients.
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Affiliation(s)
- Caroline Shadowen
- Virginia Commonwealth University School of Medicine, 1201 East Marshall Street, #4-100, Richmond, VA, 23298, USA
| | - Rachel Wheeler
- Department of Obstetrics and Gynecology, VCU Hospital System, 1101 East Marshall Street, Sanger Hall, #11-022, Richmond, VA, 23298, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA. .,National Clinician Consultation Center, University of California, San Francisco, USA.
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Martin CE, Shadowen C, Thakkar B, Oakes T, Gal TS, Moeller FG. Buprenorphine dosing for the treatment of opioid use disorder through pregnancy and postpartum. ACTA ACUST UNITED AC 2020; 7:375-399. [PMID: 33585165 DOI: 10.1007/s40501-020-00221-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of Review Opioid-related deaths are a leading cause of mortality during pregnancy through 12 months postpartum. Buprenorphine use during pregnancy is increasing, yet expert opinion on its dosing through the perinatal period is limited. We provide a review of the current clinical literature on buprenorphine dosing during pregnancy through 12 months postpartum. and present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers. Recent Findings Existing literature during pregnancy reflects how many women increase and split total daily buprenorphine doses as gestational age advances. Summary We present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers. Changes in the total daily dose of buprenorphine used across pregnancy and through 12 months postpartum at the individual level do not follow consistent patterns, highlighting substantial individual variability. Altogether, buprenorphine dosing should be individualized through pregnancy and postpartum with frequent evaluations by providers and solicited input from patients.
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Affiliation(s)
- Caitlin E Martin
- Virginia Commonwealth University, (Department of Obstetrics & Gynecology, Institute for Drug and Alcohol Studies), Richmond, (Virginia), USA
| | - Caroline Shadowen
- Virginia Commonwealth University, (School of Medicine), Richmond, (Virginia), USA
| | - Bhushan Thakkar
- Virginia Commonwealth University, (Department of Obstetrics & Gynecology), Richmond, (Virginia), USA
| | - Travis Oakes
- Virginia Commonwealth University, (Clinical Research Informatics Group, C. Kenneth and Dianne Wright Center for Clinical and Translational Research), Richmond, (Virginia), USA
| | - Tamas S Gal
- Virginia Commonwealth University, (Department of Biostatistics, School of Medicine), Richmond, (Virginia), USA
| | - F Gerard Moeller
- Virginia Commonwealth University, (Department of Psychiatry, Institute for Drug and Alcohol Studies), Richmond, (Virginia), USA
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