To investigate whether cigarette smoking and/or depression
contribute to neonatal
abstinence syndrome (NAS) severity.
Cohort study analyzing data from a randomized controlled trial of methadone versus buprenorphine.
Seven study sites that randomized patients to study conditions and provided comprehensive addiction treatment to pregnant patients.
A total of 119 of 131 opioid-dependent pregnant patients who completed the MOTHER study.
Smoking data and depression
status were obtained from the Addiction Severity Index and Mini International Neuropsychiatric Interview, respectively. Neonatal
outcomes (birth weight, preterm delivery, and NAS pharmacologic treatment) were collected from the medical charts. Study site was a fixed-effect factor in all analyses.
Cigarette smoking was reported by 94% of participants and depression
identified in 35%. Smoking was associated with low birth weight, preterm delivery, and NAS pharmacologic treatment in both depressed and nondepressed participants. The association between smoking and NAS treatment differed significantly between depressed and nondepressed participants. Among nondepressed participants, adjusting for site and illicit drug use, each additional average cigarette per day (CPD) increased the odds of NAS treatment by 12% (95% confidence interval: 1.02-1.23; P
=0.02). Among depressed participants, each additional average CPD did not statistically increase the odds of NAS treatment (odds ratio: 0.94; 95% confidence interval: 0.84-1.04; P
These results are consistent with the hypothesis that NAS expression is influenced by many factors. The relationship between CPD and NAS pharmacologic treatment is attenuated among depressed women in this study for reasons currently unknown. Further investigations are needed to clarify the complex relationships among maternal smoking, depression
, and NAS.