{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T06:28:10Z","timestamp":1774679290888,"version":"3.50.1"},"reference-count":78,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R43DA04867301A1"],"award-info":[{"award-number":["1R43DA04867301A1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. Methods: A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. Results: Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. Conclusions: The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.<\/jats:p>","DOI":"10.3390\/ijerph181910215","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T12:29:14Z","timestamp":1632832154000},"page":"10215","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Krystyna R.","family":"Isaacs","sequence":"first","affiliation":[{"name":"Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1064-1552","authenticated-orcid":false,"given":"Sravanthi","family":"Atreyapurapu","sequence":"additional","affiliation":[{"name":"Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9733-9315","authenticated-orcid":false,"given":"Amal H.","family":"Alyusuf","sequence":"additional","affiliation":[{"name":"Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Ledgerwood","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Drive, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loretta P.","family":"Finnegan","sequence":"additional","affiliation":[{"name":"Executive Officer of the College on Problems of Drug Dependence and Finnegan Consulting, Philadelphia, PA 19140, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie H. K.","family":"Chang","sequence":"additional","affiliation":[{"name":"Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3092-0572","authenticated-orcid":false,"given":"Tony X.","family":"Ma","sequence":"additional","affiliation":[{"name":"Benten Technologies, 9408 Grant Ave Suite 206, Manassas, VA 20110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3882-2953","authenticated-orcid":false,"given":"Yukiko","family":"Washio","sequence":"additional","affiliation":[{"name":"Substance Use, Gender and Applied Research, RTI International, 3040 E Cornwallis Rd, Durham, NC 27709, USA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, 3500 N Broad St, Philadelphia, PA 19140, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/AOG.0000000000002688","article-title":"Massachusetts Child Psychiatry Access Program for Moms","volume":"132","author":"Byatt","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_2","unstructured":"Center for Behavioral Health Statistics S. (2019, August 15). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables Prevalence Estimates, Standard Errors, P Values, and Sample Sizes, Available online: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/NSDUH-DetTabs-2016\/NSDUH-DetTabs-2016.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1360-0443.2012.04038.x","article-title":"Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication","volume":"107","author":"Kaltenbach","year":"2012","journal-title":"Addiction"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.drugalcdep.2012.11.019","article-title":"Cigarette smoking in opioid-dependent pregnant women: Neonatal and maternal outcomes","volume":"131","author":"Jones","year":"2013","journal-title":"Drug. Alcohol. Depend."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.siny.2012.09.002","article-title":"Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome","volume":"18","author":"McLemore","year":"2013","journal-title":"Semin. Fetal. Neonatal. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3389\/fped.2018.00033","article-title":"The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its\u2019 Origins, Assessment, and Management","volume":"6","author":"Finnegan","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/ntr\/ntn014","article-title":"Prenatal alcohol consumption and fetal growth restriction: Potentiation effect by concomitant smoking","volume":"11","author":"Aliyu","year":"2009","journal-title":"Nicotine Tob. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s00737-015-0529-9","article-title":"Marijuana use and pregnancy: Prevalence, associated characteristics, and birth outcomes","volume":"19","author":"Mark","year":"2016","journal-title":"Arch. Women\u2019s Ment. Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1007\/s10995-011-0776-y","article-title":"Infant birth outcomes among substance using women: Why quitting smoking during pregnancy is just as important as quitting illicit drug use","volume":"16","author":"Bailey","year":"2012","journal-title":"Matern. Child Health J."},{"key":"ref_10","unstructured":"Centers for Disease Control and Prevention (2018, June 07). Alcohol Use in Pregnancy, Available online: https:\/\/www.cdc.gov\/ncbddd\/fasd\/alcohol-use.html."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.3109\/14767058.2011.602143","article-title":"Prenatal hazardous substance use and adverse birth outcomes","volume":"25","author":"Quesada","year":"2012","journal-title":"J. Matern. -Fetal Neonatal Med."},{"key":"ref_12","first-page":"125","article-title":"Implementation of a statewide surveillance system for neonatal abstinence syndrome\u2014Tennessee, 2013","volume":"64","author":"Warren","year":"2015","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF03404362","article-title":"Substance use of pregnant women and early neonatal morbidity: Where to focus intervention?","volume":"101","author":"Burstyn","year":"2010","journal-title":"Can. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1080\/00952990903125235","article-title":"Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples","volume":"35","author":"Jones","year":"2009","journal-title":"Am. J. Drug Alcohol Abus."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1080\/14622200110050493","article-title":"Smoking during pregnancy and intention to quit: A profile of methadone-maintained women","volume":"3","author":"Haug","year":"2001","journal-title":"Nicotine Tob. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"419","DOI":"10.13075\/ijomeh.1896.00424","article-title":"Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment\u2014A review of epidemiological studies","volume":"28","author":"Polanska","year":"2015","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s11920-015-0626-5","article-title":"Substance use in the perinatal period","volume":"17","author":"Forray","year":"2015","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.15585\/mmwr.mm6718a3","article-title":"Tobacco cessation interventions and smoke-free policies in mental health and substance abuse treatment facilities\u2014United States, 2016","volume":"67","author":"Marynak","year":"2018","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_19","unstructured":"Substance Abuse and Mental Health Services Administration (2021, August 29). Buprenorphine, Available online: https:\/\/www.samhsa.gov\/medication-assisted-treatment\/medications-counseling-related-conditions\/buprenorphine."},{"key":"ref_20","unstructured":"Substance Abuse and Mental Health Services Administration (2021, August 29). Methadone, Available online: https:\/\/www.samhsa.gov\/medication-assisted-treatment\/medications-counseling-related-conditions\/methadone."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jpeds.2008.07.048","article-title":"Maternal smoking during pregnancy and newborn neurobehavior: Effects at 10 to 27 days","volume":"154","author":"Stroud","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1542\/peds.111.6.1318","article-title":"Smoking during pregnancy and newborn neurobehavior","volume":"111","author":"Law","year":"2003","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1542\/peds.113.S2.634","article-title":"History and description of the Neonatal Intensive Care Unit Network Neurobehavioral Scale","volume":"113","author":"Lester","year":"2004","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/14767050500123731","article-title":"Iqmik\u2014A form of smokeless tobacco used by pregnant Alaska natives: Nicotine exposure in their neonates","volume":"17","author":"Hurt","year":"2005","journal-title":"J. Matern. -Fetal Neonatal Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1203\/01.PDR.0000112099.88740.4E","article-title":"Does in utero exposure to heavy maternal smoking induce nicotine withdrawal symptoms in neonates?","volume":"55","author":"Godding","year":"2004","journal-title":"Pediatr. Res."},{"key":"ref_26","first-page":"e1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1162\/qss_a_00019","article-title":"Scopus as a curated, high-quality bibliometric data source for academic research in quantitative science studies","volume":"1","author":"Baas","year":"2020","journal-title":"Quant. Sci. Stud."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Schardt, C., Adams, M.B., Owens, T., Keitz, S., and Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inform. Decis. Mak., 7.","DOI":"10.1186\/1472-6947-7-16"},{"key":"ref_29","unstructured":"Friedman, S.B., Nelson, N., and Seidel, H.M. (1992). The assessment and management of Neonatal Abstinence Syndrome. Primary Care, C.V. Mosby Company. [3rd ed.]."},{"key":"ref_30","first-page":"141","article-title":"Neonatal abstinence syndrome: Assessment and management","volume":"2","author":"Finnegan","year":"1975","journal-title":"Addict. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5055\/jom.2009.0006","article-title":"The opioid-exposed newborn: Assessment and pharmacologic management","volume":"5","author":"Jansson","year":"2009","journal-title":"J. Opioid. Manag."},{"key":"ref_32","unstructured":"(2021, August 15). Evidence-Based Recommendations\u2013GRADE, Available online: www.cdc.gov."},{"key":"ref_33","unstructured":"McMaster University (2013). GRADE 2014, McMaster University."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/j.1398-9995.2009.01973.x","article-title":"Grading quality of evidence and strength of recommendations in clinical practice guidelines","volume":"64","author":"Akl","year":"2009","journal-title":"Allergy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1080\/09595230701494416","article-title":"Using population data to examine the prevalence and correlates of neonatal abstinence syndrome","volume":"26","author":"Burns","year":"2007","journal-title":"Drug Alcohol Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.drugalcdep.2004.03.012","article-title":"Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure","volume":"75","author":"Choo","year":"2004","journal-title":"Drug Alcohol Depend."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.jpeds.2010.03.033","article-title":"Relationship between maternal methadone dose at delivery and neonatal abstinence syndrome","volume":"157","author":"Seligman","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/ADM.0000000000000186","article-title":"Cigarette smoking reduction in pregnant women with opioid use disorder","volume":"10","author":"Ram","year":"2016","journal-title":"J. Addict. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1111\/j.1360-0443.2012.03844.x","article-title":"Methadone and perinatal outcomes: A prospective cohort study","volume":"107","author":"Cleary","year":"2012","journal-title":"Addiction"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1097\/FTD.0b013e31822724f0","article-title":"Methadone, cocaine, opiates, and metabolite disposition in umbilical cord and correlations to maternal methadone dose and neonatal outcomes","volume":"33","author":"Jones","year":"2011","journal-title":"Ther. Drug Monit."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/14767050701490327","article-title":"Maternal vagal tone change in response to methadone is associated with neonatal abstinence syndrome severity in exposed neonates","volume":"20","author":"Jansson","year":"2007","journal-title":"J. Matern. -Fetal Neonatal Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.ajog.2008.06.088","article-title":"Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates","volume":"199","author":"Seligman","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1203\/PDR.0b013e3181bc035d","article-title":"Prenatal methadone exposure and neonatal neurobehavioral functioning","volume":"66","author":"Velez","year":"2009","journal-title":"Pediatr. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1111\/j.1360-0443.2010.03097.x","article-title":"Prenatal methadone exposure, meconium biomarker concentrations and neonatal abstinence syndrome","volume":"105","author":"Gray","year":"2010","journal-title":"Addiction"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.drugalcdep.2010.01.004","article-title":"Infant autonomic functioning and neonatal abstinence syndrome","volume":"109","author":"Jansson","year":"2010","journal-title":"Drug Alcohol Depend."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"194","DOI":"10.3122\/jabfm.2011.02.100155","article-title":"Observational study of buprenorphine treatment of opioid-dependent pregnant women in a family medicine residency: Reports on maternal and infant outcomes","volume":"24","author":"Alto","year":"2011","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1046\/j.1360-0443.2000.95223910.x","article-title":"Treatment of opioid-dependent pregnant women with buprenorphine","volume":"95","author":"Fischer","year":"2000","journal-title":"Addiction"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1038\/clpt.2008.156","article-title":"Correlations of maternal buprenorphine dose, buprenorphine, and metabolite concentrations in meconium with neonatal outcomes","volume":"84","author":"Kacinko","year":"2008","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.drugalcdep.2017.08.001","article-title":"Maternal buprenorphine treatment and infant outcome","volume":"180","author":"Jansson","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1159\/000210042","article-title":"Opioid maintenance treatment during pregnancy: Occurrence and severity of neonatal abstinence syndrome","volume":"15","author":"Bakstad","year":"2009","journal-title":"Eur. Addict. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/ADT.0b013e31821cadbd","article-title":"Cigarette smoking and neonatal outcomes in depressed and non-depressed opioid-dependent agonist-maintained pregnant patients","volume":"10","author":"Chisolm","year":"2011","journal-title":"Addict. Disord. Their Treat."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/ADM.0b013e3182266a3a","article-title":"The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence syndrome","volume":"5","author":"Wachman","year":"2011","journal-title":"J. Addict. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/add.13703","article-title":"The relationship between gestational age and the severity of neonatal abstinence syndrome","volume":"112","author":"Gibson","year":"2017","journal-title":"Addiction"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1360-0443.2006.01321.x","article-title":"Methadone versus buprenorphine in pregnant addicts: A double-blind, double-dummy comparison study","volume":"101","author":"Fischer","year":"2006","journal-title":"Addiction"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1159\/000216466","article-title":"Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment","volume":"15","author":"Winklbaur","year":"2009","journal-title":"Eur. Addict. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/jp.2017.157","article-title":"Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome","volume":"38","author":"Tolia","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e614","DOI":"10.1542\/peds.2008-2888","article-title":"Increasing prevalence of neonatal withdrawal syndrome: Population study of maternal factors and child protection involvement","volume":"123","author":"Nassar","year":"2009","journal-title":"Pediatrics"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fped.2017.00238","article-title":"Plasma brain-derived neurotrophic factor levels in newborn infants with neonatal abstinence syndrome","volume":"5","author":"Subedi","year":"2017","journal-title":"Front. Pediatr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1542\/peds.2014-3299","article-title":"Prescription opioid epidemic and infant outcomes","volume":"135","author":"Patrick","year":"2015","journal-title":"Pediatrics"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"h2102","DOI":"10.1136\/bmj.h2102","article-title":"Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: Population based cohort study","volume":"350","author":"Desai","year":"2015","journal-title":"BMJ"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/ajh.24307","article-title":"Maternal opioid dose is associated with neonatal abstinence syndrome in children born to women with sickle cell disease","volume":"91","author":"Shirel","year":"2016","journal-title":"Am. J. Hematol."},{"key":"ref_62","first-page":"1119","article-title":"The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Addiction"},{"key":"ref_63","unstructured":"Substance Abuse and Mental Health Services Administration (2020, August 15). Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants, Available online: https:\/\/store.samhsa.gov\/product\/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants\/SMA18-."},{"key":"ref_64","unstructured":"World Health Organization (2020, August 20). Management of Substance Abuse Team. Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. Available online: https:\/\/www.who.int\/publications\/i\/item\/97892415487312014."},{"key":"ref_65","unstructured":"(2018, August 20). ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Available online: https:\/\/www.asam.org\/docs\/default-source\/practice-support\/guidelines-and-consensus-docs\/asam-national-practice-guideline-supplement.pdf?sfvrsn=24."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s10995-020-02892-9","article-title":"Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) for Substance Use into Prenatal Care","volume":"24","author":"Hostage","year":"2020","journal-title":"Matern. Child Health J."},{"key":"ref_67","unstructured":"Substance Abuse and Mental Health Services Administration (2020, August 20). You Can Quit Tobacco Benefits and Tips for Quitting for Good If Your Last Smoke Was: 12 Hours Ago, Available online: https:\/\/www.who.int\/news-room\/q-a-detail\/tobacco-health-benefits-of-smoking-cessation."},{"key":"ref_68","unstructured":"Substance Abuse and Mental Health Services Administration HPNS-5069QT (2020, August 20). Quitting Tobacco Help Your Clients to a Healthier Life Resources for Implementing Tobacco Cessation, Available online: https:\/\/store.samhsa.gov\/product\/Quitting-Tobacco\/SMA18-5069QT."},{"key":"ref_69","unstructured":"Substance Abuse and Mental Health Services\u2014SAMHSA SMA18-5069QG (2018, August 20). Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings, Available online: https:\/\/store.samhsa.gov\/product\/SMA18-5069QG."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jsat.2014.12.002","article-title":"Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: A systematic review","volume":"52","author":"Akerman","year":"2015","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1037\/0893-164X.18.3.289","article-title":"Motivational enhancement therapy for nicotine dependence in methadone-maintained pregnant women","volume":"18","author":"Haug","year":"2004","journal-title":"Psychol. Addict. Behav."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2011\/567056","article-title":"Effectiveness of a smoking cessation intervention for methadone-maintained women: A comparison of pregnant and parenting women","volume":"2011","author":"Holbrook","year":"2011","journal-title":"Int. J. Pediatr."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3109\/00952990.2011.643977","article-title":"Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioid-dependent pregnant women","volume":"38","author":"Tuten","year":"2012","journal-title":"Am. J. Drug Alcohol Abuse."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.jogn.2018.08.004","article-title":"Pilot Tobacco Treatment Intervention for Women in Residential Treatment for Substance Use Disorder","volume":"47","author":"Barnett","year":"2018","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e032330","DOI":"10.1136\/bmjopen-2019-032330","article-title":"The Incentives to Quit tobacco in Pregnancy (IQuiP) protocol: Piloting a financial incentive-based smoking treatment for women attending substance use in pregnancy antenatal services","volume":"9","author":"Jackson","year":"2019","journal-title":"BMJ Open"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s10995-018-2457-6","article-title":"Mental Health of Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Opioid Exposure","volume":"22","author":"Faherty","year":"2018","journal-title":"Matern. Child Health J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1093\/ntr\/ntaa066","article-title":"Pregnant smokers receiving opioid agonist therapy have an elevated nicotine metabolite ratio: A replication study","volume":"22","author":"Kranzler","year":"2021","journal-title":"Nicotine Tob. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jogn.2017.06.007","article-title":"Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids","volume":"46","author":"Ashford","year":"2017","journal-title":"J. Obstet. Gynecol. 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