No abstract

A retrospective case note study of 93 women was performed in order to assess the effect of maternal factors on neonatal outcome in a group of women attending a specialist clinic for pregnant drug users. There were no significant differences in outcome for chaotic drug users compared with non-chaotic drug users, or for cocaine users compared with non-cocaine using drug users. Women who reduced their methadone dose during pregnancy delivered babies of significantly higher birth weight than those whose methadone dose remained the same or increased (median 3027 g, range 1780-3629 g vs 2645 g, range 580-3720 g). Women who abused benzodiazepines during pregnancy produced babies of significantly lower birth weight than those women who did not use benzodiazepines (median 2100 g, range 580-3520 g vs 2767 g, range 1530-3720 g). The results of this study give healthcare staff evidence to use in encouraging drug-using women to avoid benzodiazepines during pregnancy and to reduce their methadone dosage. The treatment received from a specialist clinic may mitigate against some of the other recognised effects of drug use during pregnancy.

Drug misuse increasing in women of childbearing age and the management of the drug affected neonate varies widely, with inconsistent policies on determining the presence of NOW and how to treat it.

A retrospective study of 103 opiate-dependent women in Liverpool compared their outcomes of pregnancy with those of non-drug-misusing controls matched by age, parity and postal code. The study group were all on a methadone programme and received regular antenatal care.

This study describes the first two years of an obstetric liaison service between the Liverpool Drug Dependency Clinic and the two local maternity hospitals. The service comprised, medical officer, drug liaison midwife and a designated obstetrician at each of the hospitals. A total of 88 women were seen from whom there were 60 deliveries producing 61 babies. Only two women delivered without either service identifying their pregnancy. This compares to a previous estimated rate of 75% of drug users being undetected by the obstetric services. The amount of methadone a woman was taking did not predispose to any specific obstetric intervention. There was a higher rate of small for gestational age babies in this group but other factors may be more important than a mothers drug use. Higher levels of maternal methadone did not reduce foetal weight. There was a tendency to increase the risk of neonatal opiate withdrawal symptoms and premature labour with higher doses of methadone, although this requires further study. The multidisciplinary approach of the Liverpool Drug Dependency Clinic allowed in a majority of cases for assessments prior to delivery, so reducing the number of crisis child protection conferencing after birth. The multidisciplinary team endeavoured to establish normalisation policies for other health care workers who have contact with pregnant drug users on treatment, and in so doing, encouraged a change in the general midwifery staffs attitudes, to be more positive and accepting rather than discriminatory.We suggest that prescribing methadone within a harm reduction philosophy has produced acceptable outcomes for opiate dependent women and their babies.