Introduction
The impact of drug addiction on a pregnant woman has profound effects, not only on her health and wellbeing but also that of her newborn baby. Neonatal Abstinence Syndrome (NAS) is a classification for neonatal withdrawal symptoms from maternal use of drugs of addiction. Maternal substance use during pregnancy is an important risk factor for negative pregnancy and neonatal outcomes. The infant at risk for NAS is also at increased risk for pre-term birth, low birth weight and intrauterine growth restriction. Substance use in pregnancy is a marker for social and environmental risks that contribute to mental, physical and developmental challenges for infants and children that may last a lifetime.
The Neonatal Abstinence Work Group focused primarily on NAS resulting from opioid dependence and does not address the management of NAS resulting from the use of selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, barbiturates, ethanol, sedatives, and hypnotics. The Work Group’s Recommendations, which have been approved by the PCMCH, address the psychosocial needs of opioid dependent women during the preconception, antenatal and postpartum/post discharge stages as well as the needs of the infants born to these women. They utilized research based on quality of the evidence and classification of the recommendations according to the Canadian Task Force on Preventive Health Care definitions listed in the Table below:
Levels of Evidence Defined
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Key to evidence statements and grading of recommendations, using the ranking of the Canadian Task Force on Preventive Health Care*
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Quality of Evidence Assessment**
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Classification of Recommendations***
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| I |
Evidence obtained from at least one properly randomized controlled trial |
A. |
There is good evidence to recommend the clinical preventive action |
| II-1 |
Evidence from well-designed controlled trials without randomization |
B. |
There is fair evidence to recommend the clinical preventive action |
| II-2 |
Evidence from well-designed cohort (prospective or retrospective) or cased-control studies, preferably from more than one centre or research group |
C. |
The existing evidence is conflicting and does not allow a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making |
| II-3 |
Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category |
D. |
There is fair evidence to recommend against the clinical preventive action |
| E. |
There is good evidence to recommend against the clinical preventive action |
| III |
Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees |
L. |
There is sufficient evidence (in quality or quantity) to make a recommendation; however, other factors may influence decision making |
| *Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-8 |
| **The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care |
| ***Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care. |
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