Methadone and the pregnant user: a matter for careful clinical consideration (original) (raw)
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Infant mortality among women on a methadone program during pregnancy
Drug and Alcohol Review, 2010
Introduction and Aims. The rate and correlates of infant death in those born to opioid-dependent women are unclear.This study aims to determine the infant mortality rate of infants born to women on a methadone program during pregnancy and to identify any modifiable risk factors. Design and Methods. A retrospective study of live births to all women in New South Wales, Australia during the period 1995-2002. Using record linkage four groups were compared: (i) live births to women on a methadone program during pregnancy who subsequently died during infancy; (ii) live births to women not on a methadone program who subsequently died during infancy; (iii) live births to women on a methadone program during pregnancy who did not die during infancy; and (iv) live births to women not on a methadone program who did not die during infancy. Results, Discussion and Conclusion. The infant mortality rate was higher among infants whose mothers were on methadone during pregnancy (24.3 per 1000 live born infants in group 1 and 4.0 per 1000 live born infants in group 2) compared with infants of all other mothers.The single main cause of death for all infants was Sudden Infant Death Syndrome.There was a higher rate of smoking among women on methadone.The findings suggest that methadone and non-methadone infant-mother pairs have different symptom profiles, diagnostic procedures and/or different patterns of access to care. [Burns L, Conroy E, Mattick RP. Infant mortality among women on a methadone program during pregnancy. Drug Alcohol Rev 2010;29;551-556]
Improving treatment outcome in pregnant opiate-dependent women
Journal of Substance Abuse Treatment, 1992
Outcomes for 6 pregnant methadone-maintained opiate-dependent subjects in enhanced treatment were compared to those of 6 women receiving conventional methadone maintenance. Enhanced treatment consisted of weekly prenatal care, relapse prevention groups, thrice weekly urine toxicology screening with positive contingency awards for abstinence, and therapeutic child care during treatment visits in addition to treatment as usual. Treatment as usual included daily methadone, group counseling, and random urine toxicology screening. Study patients differed from the comparison group in three important ways, having fewer urine toxicology screens positive for illicit substances (59% vs. 76%), three times as many prenatal visits (8.8 vs. 2.7), and heavier infants (median birth weight, 2959 vs. 2344 grams). These results suggest that enhanced drug treatment can improve pregnancy outcome and, in particular, reduce low birth weight for this high-risk population.
Integrated care for pregnant women on methadone maintenance treatment
Canadian Family Physician, 2013
Web exclusive editor's key points • This national cohort of opioiddependent pregnant women was characterized by a mean age of 29.7 years, white or aboriginal ethnicity, and reliance on social assistance. A history of concurrent psychiatric disorders was also prevalent in this population. • All 3 programs had excellent clinical outcomes, with marked reductions in heroin, prescription opioid, alcohol, cocaine, and cannabis use from the initial visit to the time of delivery. Despite the variability in services at the 3 sites, the programs were equally effective. This might be attributable to their common treatment philosophy-providing care in a safe environment where women are treated with respect and dignity. This article has been peer reviewed.
International Journal of Drug Policy, 2015
Aims: To identify sociodemographic and clinical factors predicting the overall risk of adverse obstetric outcomes and the length of maternal hospital stay among heroin-exposed and methadone-treated women in Taiwan. Methods: Using the retrospective matched cohort study design, 396 births to women on methadone treatment during pregnancy (the methadone-treated group) and 609 to women who started methadone treatment after childbirth (the heroin-exposed group) were identified in the National Methadone Maintenance Program. Adverse pregnancy outcomes were assessed by still birth, low birth weight and preterm delivery. We used multivariate methods and zero-truncated negative binomial regression to evaluate association estimates. Finding: Both heroin-exposed and methadone-treated women had 2-4-fold greater risk of adverse pregnancy outcomes. HIV infection increased the overall risk of adverse pregnancy outcome in the methadone-treated group, whereas being unmarried and having treatment history of substance use disorders increased such risk in the heroin-exposed group. Maternal ages at delivery and healthcare facility used had moderate effects on the length of maternal hospital stay; HIV infection significantly increased the length of hospital stay for women in the heroin-exposed group (adjusted relative risk = 1.32, 95% CI = 1.05-1.68). Conclusions: Our results showed no appreciable differences in the occurrence of adverse obstetric outcomes and the length of maternity hospitalization between the methadone-treated and the heroinexposed women; the profile of sociodemographic and clinical predictors was similar as well. Coordination of addiction treatment and prenatal care may help reduce unfavorable obstetric outcomes among female heroin addicts seeking substitution treatment.
Methadone in pregnancy: treatment retention and neonatal outcomes
Addiction, 2007
Aim To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Design Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Measurements Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. Findings There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. Conclusion Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented.
Maternal methadone dose during pregnancy and infant clinical outcome
Neurotoxicology and Teratology, 2013
In recent decades there has been an increase in the methadone dosages prescribed for opioid dependent women during pregnancy. Using prospective longitudinal data from a cohort of 32 methadone exposed and 42 non-methadone exposed infants, this study examined the relationship between maternal methadone dose during pregnancy and a range of infant clinical outcomes. Of particular interest was the extent to which any observed associations might reflect the direct causal effects of maternal methadone dose and/or the confounding effects of adverse maternal lifestyle factors correlated with methadone use during pregnancy. Findings revealed the presence of clear linear relationships between the mean methadone dose prescribed for mothers during pregnancy and a range of adverse infant clinical outcomes. With increasing maternal methadone dose there was a corresponding increase in infants' risk of being born preterm, being symmetrically smaller, spending longer periods in hospital and the need for treatment for Neonatal Abstinence Syndrome. After due allowance for potentially confounding maternal health and lifestyle factors, maternal methadone dose during pregnancy remained a significant predictor of preterm birth, growth, and the duration of infant hospitalization post delivery. These findings suggest a need to examine more closely the potential impacts of recent trends towards the use of higher methadone dose levels during pregnancy.
Prevalence of narcotic substance abuse and the maternal and fetal outcomes in pregnant women
Pars of Jahrom University of Medical Sciences
Introduction: Nowadays, substance abuse has crossed many social, economic and geographical boundaries, presenting itself as a major health challenge. It affects many demographic groups, including pregnant women, rendering them susceptible to maternal and fetal complications. The aim of the present study is to investigate the prevalence of narcotics abuse in pregnant women, as well as the ensuing maternal and fetal outcomes. Material and Methods: This is a descriptive-analytic study conducted on all pregnant women referring to the obstetric department from October 2006 to December 2007. Data were collected using questionnaires, and analyzed with SPSS software. Results: The prevalence of addiction was 0.69% in women admitted for delivery. The mean age of addicted women was 29.4 ± 1.32 years and the most frequent age subgroup (45.5%) pertained to ages 20-29 years. In the women studied, we found 11.4% placental abruption, 10% stillbirth, and 37.6% fetal distress. The mean gestational age was 34.6 ± 1.34 weeks, with addicted women having a significantly higher prevalence of premature delivery (p≤0.01). The odds ratio (OR) for premature delivery was 5.96 times higher for addicted women. Conclusion: Despite the small number of pregnant addicts, they constitute a high-risk population in terms of perinatal outcomes. Therefore, the educational programs during pregnancy must focus on rehabilitation or substitution of narcotics with safer drugs.
Neurotoxicology and Teratology, 2013
Pregnant women with substance dependency are a high-risk psychiatric and obstetric population, with their infants also at elevated neonatal risk. This paper draws on prospective, longitudinal data from a regional cohort of 81 methadone-maintained (MM) and 107 comparison women and their infants to describe the obstetric, socio-familial and mental health needs of women in methadone maintenance treatment during pregnancy. Of particular interest was the extent and pattern of maternal licit and illicit drug use over the course of pregnancy. Results showed that MM women had complex reproductive histories, chronic health problems, and were subject to high rates of socioeconomic adversity and comorbid mental health problems. During pregnancy, more than half continued to use licit and illicit drugs, although there was a general trend for drug use to reduce over time. No differences were observed between women maintained on low (12.5-61.0 mg/day) and high (61.1-195.0 mg/day) doses of methadone, with the exception of opiate abuse which was higher in the low dose group (p = .07). Findings highlight that pregnant women enrolled in MMT and their infants represent a vulnerable group with complex, social, obstetric and psychiatric needs. They also reinforce the need for services that can provide on-going wrap-around, multidisciplinary and multiagency care for these high risk dyads, both during pregnancy and in the transition to parenthood.