Narcotic tapering in pregnancy using long-acting morphine: an 18-month prospective cohort study in northwestern Ontario.

OBJECTIVE To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy. DESIGN A prospective cohort study over 18 months. SETTING Northwestern Ontario. PARTICIPANTS All 600 births at Meno Ya Win Health Centre in Sioux Lookout, Ont, from January 1, 2012, to June 30, 2013, including 166 narcotic-exposed pregnancies. INTERVENTION Narcotic replacement and tapering of narcotic use with long-acting morphine preparations. MAIN OUTCOME MEASURES Prenatal management of maternal narcotic use, incidence of neonatal abstinence syndrome, and other neonatal outcomes. RESULTS The incidence of neonatal abstinence syndrome fell significantly to 18.1% of pregnancies exposed to narcotics (from 29.5% in a previous 2010 study, P = .003) among patients using narcotic replacement and tapering with long-acting morphine preparations. Neonatal outcomes were otherwise equivalent to those of the nonexposed pregnancies. CONCLUSION In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.