Wrap-Up Discussion
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su_phe5020_w5_a2b_tolinp.pptxAnalysis of a Biostatistical Article “A Pilot Study of the Nutritional States of Opiate-using Pregnant Women on Methadone Maintenance Therapy”
PHE 5020
Priscilla Tolin MSN, RN
Intro
Article studied the nutritional intake of pregnant women in a methadone maintenance program
This study is significant due to the importance of healthy prenatal habits for the pregnant woman and her fetus
This article used reputable resources such as the Institute of Medicine, the National Institute of Health and the National Institute of Child Health and Human Development to provide important information needed for the background and rationale for this study.
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Data
National estimates of opiate use in pregnancy are low due to a limited number of women self reporting opiate use
Screening studies have identified that 1.0-2.6% of pregnant women misuse opiates
Data
Opiate use during pregnancy puts the fetus at risk i.e.
Preterm birth
Low birth weight
Neonatal withdrawal symptoms
Methadone programs are encouraged as effective treatment
Maintenance therapy with methadone has been the standard of treatment in opioid addiction in pregnancy to prevent complications of opioid use and narcotic withdrawal, encourage prenatal care and drug treatment and avoid risks to the patient associated with a drug culture ("Opioid Abuse," 2012).
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Data
Poor nutrition negatively impacts pregnancy
Micronutrient deficiencies are detrimental to pregnancy
Women who are underweight and have inadequate energy are at risk for adverse pregnancy outcomes
Data collected for this study identified that maternal micronutrient deficiencies are detrimental to pregnancy and women who are underweight before pregnancy or those that do not have adequate energy intake are at risk for adverse pregnancy outcomes (Tomedi et al, 2012). Women should try to conceive at a normal weight for better obstetrical outcomes and improved preconception care is necessary in helping women to reach this goal (Rasmussen, Catalano, & Yaktine, 2009).
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Hypothesis
Opiate using pregnant patients on methadone therapy will have more nutritional deficiencies compared to non-drug using pregnant patients
This pilot study is to describe the nutritional status of a cohort of opiate dependent pregnant women treated with methadone compared to a cohort od non-drug using pregnant women (Tomedi et al, 2012).
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Study Design Methods
Located at Magee Women’s Hospital in Pittsburgh, Pennsylvania 2006-08
Eligibility
20-35 weeks’ gestation
Compliant with methadone treatment
Participants N=22 opiate users eligible
In order to be eligible, pregnant women that were 20-35 weeks’ gestation that were attending a methadone treatment program had to be compliant with the treatment, be HIV negative, intend on maintaining the pregnancy, not placing the baby up for adoption, and delivering their baby at Magee Women’s Hospital (Tomedi et al, 2012). The participants in this study were given information about the details of this study and signed informed written consent before participating. Initial information that was gathered during their third trimester included their height and pre-pregnant weight (Tomedi et al, 2012). The participants were also given a Food Frequency Questionnaire (FFQ) to report their usual dietary intake in the past 3 months and they were required to give blood samples to assess for biomarkers of nutrition (Tomedi et al, 2012).
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Study Design Methods
Control Group
Eligibility
20-35 weeks’ gestation
Non-drug users
Participating in antidepressant study
Participants N= 119 non-drug users eligible
Study Design Methods
Data gathered from three methods
Food Frequency Questionnaire
Tracked food intake over 3 months
Biological markers in blood sample
Measures micronutrients
Self reported demographic details
Statistical Analysis
Pearson Chi-Square test
Student’s t-test
Multivariable linear regression models assessed independent associations between variables
The FFQ was semi quantitative and provided a projection of the amount of nutrients consumed by the participants (Tomedi et al, 2012). In order to analyze the level of micronutrients and essential fatty acids consumed by participants, blood samples were drawn to measure biological markers. The blood samples were analyzed in a duplicate, blinded fashion measuring plasma folate, maternal vitamin D, plasma ascorbic acid, serum carotenoids, and serum ferritin and essential fatty acids (Tomedi et al, 2012).
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Statistical Findings
Methadone participants
Lower BMI
Mean 22.9 vs 26.4 in control group, p=.02
Higher energy intake from sweets
Mean 23% vs 12.9% in control group, p< .01
Lower concentrations of micronutrients
Ex. Vitamin C 70.5 mg/day vs 90.6 mg/day in control group
Discussion
“Our pilot study found that methadone maintained pregnant women may be at an increased risk of entering pregnancy underweight and with nutritional deficiencies”
(Tomedi et al, 2012, p. 192)
The findings in this study are important because it identifies problems with the nutritional status of methadone treated pregnant patients. Despite having similar intake as the control group, the methadone maintained pregnant women had significantly poorer status for several of the micronutrients (Tomedi et al, 2012). Identifying problems such as this can lead to further research for interventions to prevent these nutritional deficiencies in this patient population.
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Limitations
Small sample size of methadone treated patients
Strict methadone program compared to general population
Food Frequency questionnaire results based on memory of participants
Gaps in research were identified by the authors regarding research that analyzes the nutritional needs of opiate users entering treatment and the examination of the nutritional status of pregnant women prescribed methadone. It would be interesting to compare which stage of recovery the patient is in compared to their nutritional status. The research could identify if there is an improvement in the nutritional status the longer they are participating in the methadone maintenance therapy and the further along that they are in their recovery. This study could also be could also be conducted with a larger group in multiple geographical settings in the United States to compare the nutritional status among a wide variety of methadone treated pregnant patients. Comparing the differences can identify if there are outside influences that are helping or hindering the adequate nutritional status for their pregnancy.
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References
Opioid abuse, dependence and addiction in pregnancy. (2012). Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy
Rasmussen, K., Catalano, P., & Yaktine, A. (2009). New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Current Opinion in Obstetrics and Gynecology, 21(6), 521-526. http://dx.doi.org/http://doi.org/10.1097/GCO.0b013e328332d24e
Tomedi, L., Bogen, D., Hanusa, B., Wisner, K., & Bodnar, L. (2012). A pilot study of the nutritional status of opiate using pregnant women on methadone maintenance therapy. Substance Use & Misuse , 47(3), 286-295.
