Die Empfehlungen zum Stillen bei opiatabhängigen Müttern bleiben ein viel diskutiertes Thema. Da Methadon derzeit Standard in der Substitutionsbehandlung opiatabhängiger Schwangerer ist, wurden für diese Substanz auch verschiedene Studien zur Abschätzung des Risikos für gestillte Neugeborene durchgeführt. Nach Durchsicht der aktuellen Literatur rechtfertigt die reine Opiatsubstitution nicht mehr das primäre Abstillen. Obgleich die untersuchten Fallzahlen klein sind, konnte in der Muttermilch abhängiger Mütter, als auch im Plasma deren Neugeborener, Methadon in nur minimalen Konzentrationen nachgewiesen werden. Offensichtlich variiert der Methadonmetabolismus individuell, so dass die Dosis kaum mit den Plasmaspiegeln korreliert. Veraltete Empfehlungen, Stillen ausschließlich bei sehr niedriger Methadondosis zuzulassen, wurden daher revidiert. Bei Methadonsubstitution muss jedoch an die Möglichkeit eines politoxikomanen Beigebrauches sowie an das Vorliegen einer HIV-Infektion gedacht werden, in diesen Fällen ist vom Stillen abzuraten. Schlüsselwörter Methadon · Opiatabhängigkeit · Buprenorphin · Stillen AbstractWeaning in opiate addicted mothers remains a matter of debate. As methadone is the substance of choice in the treatment of opiate addiction in pregnancy, various studies have been conducted to evaluate its potential risk for the breastfed neonate. Reviewing the current literature we came to the conclusion that study results are not sufficient to recommend general weaning in women under opiate maintenance treatment. Although the numbers of cases investigated are small, the concentration of methadone or alternative opiates in breast milk or the infant's plasma seems to be neglible. Prior recommendations to promote breastfeeding only in mothers treated with lower methadone doses have had to be retracted. There is now evidence that methadone metabolism differs individually and a correlation between methadone dosage and maternal plasma concentrations has not been confirmed. Nevertheless polytoxic behaviour with consumption of various toxic substances has to be taken into consideration and likewise the high infection rate with HIV in the opiate addicted patient. In these cases weaning should be recommended.
In the group of fetuses monitored by fetal pulse oximetry there was no increase in fetal or maternal infectious morbidity. There was no evidence of adverse side effects which might limit the advantage of continuous oxygen saturation monitoring.
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