Prenatal tobacco exposure is associated with a number of medical and developmental consequences including low birth weight and increased mortality. In fact, prenatal smoking may be more harmful to the developing fetus than illicit drugs such as opioids, cocaine and marijuana. One group of pregnant patients that is a greater risk for both tobacco smoking and additional adverse outcomes during pregnancy and the neonatal period is pregnant methadone treated women. In contrast to a general population of pregnant women, little is known about the smoking and quitting behavior of methadone treated pregnant women and how reduction of tobacco exposure may impact the incidence of neonatal abstinence syndrome (NAS) that occurs in 55-95% of methadone-exposed neonates. This becomes especially import to determine the role that tobacco plays in the prevalence and severity of NAS since tobacco exposure alone has been associated with withdrawal symptomatology that is similar to the NAS produced by opioid exposure. Using a 2 group randomized design (tobacco abstinent contingent behavioral incentives versus non-contingent incentives n = 64 per group; total 128 subjects), a study will be conducted to assess the effectiveness of tobacco abstinent contingency management for reducing prenatal tobacco use and the incidence and severity of NAS. Tobacco use (verified by carbon monoxide and/or urinary cotinine and self report of cigarettes smoked), illicit drug use, and other psychosocial outcomes will be examined at 1 and 3 month follow-ups and 6 weeks postpartum. Birth outcomes of presence and severity NAS and physical birth outcomes including but not limited to birth weight, estimated gestational age at delivery, length and head circumference will also be compared across groups. It is hypothesized that compared to the non-contingent incentive group, the tobacco abstinent contingent intervention group will result in less tobacco use and improved birth outcomes (i.e., reduced severity of and treatment for NAS and heavier birth weights). This project will make substantial contributions to the understanding of tobacco use and cessation in pregnant women and the role tobacco has on the incidence and severity of NAS in methadone-maintained women.
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