High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome

Lim, Susie; Prasad, Mona; Samuels, Philip; Gardner, Debra K.; Cordero, Leandro

doi:10.1016/j.ajog.2008.08.041

Cited by 62 publications

(49 citation statements)

References 15 publications

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“…12,29 Research on the pharmacokinetics of methadone during pregnancy has led to the administration of higher methadone doses than were used 20 years ago 30,31 ; however, it is unclear if these increases in maternal methadone dose have further increased the incidence of NAS. [32][33][34][35][36][37] Buprenorphine, a semisynthetic partial m-opioid receptor agonist and a complete k-opioid receptor antagonist, has been found to be equally safe and efficacious and has become an effective alternative to methadone for opioid dependency during pregnancy. [38][39][40] Multiple studies demonstrated that buprenorphine maintenance treatment in pregnancy is either comparable or superior to methadone treatment with regard to NAS; however, these studies were observational, retrospective, or small (Supplemental Table 5).…”

Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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“…Maintenance treatment with methadone provides a steady concentration of opiate in the pregnant women's circulation and therefore prevents acute maternal withdrawal that is associated with fetal death. Maternal methadone, however, is also associated with neonatal abstinence syndrome [ 74 ] .…”

Section: Opioidsmentioning

confidence: 99%

“…Methadone is inexpensive and has been shown to dramatically reduce the incidence of criminal behavior in the mother, including prostitution, and diminish exposure to needleborne infections [ 11 ] . Women who use methadone have decreased use of illicit drugs, better compliance with prenatal care, better obstetric outcomes, and improved infant birth weights [ 74 ] . Maintenance treatment with methadone provides a steady concentration of opiate in the pregnant women's circulation and therefore prevents acute maternal withdrawal that is associated with fetal death.…”

Section: Opioidsmentioning

confidence: 99%

Drugs, Alcohol, and Pregnant Women: Anesthetic Implications for Mother and Newborn

Saloum

Epstein

2011

Perioperative Addiction

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“…En ce qui concerne la période néonatale, un peu plus de la moitié des nouveau-nés exposés à la méthadone vont présen-ter des symptômes de sevrage des opiacés (Dryden, Young, Hepburn & Mactier, 2009 ;Lim, Prasad, Samuels, Gardner & Cordero, 2009). Dans une de ces études, la fréquence du syndrome d'abstinence néonatal s'établissait à 45 %.…”

Section: Drogues Santé Et Société Vol 10 N O 1 Juin 2011unclassified

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

Lauzon

2012

dss

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Le traitement de substitution, principalement avec la méthadone ou la buprénorphine, représente le traitement le plus efficace de la dépendance des opioïdes. Ces médicaments doivent, la plupart du temps, être pris pendant des périodes prolongées, soit plusieurs années ou toute la vie pour certains. Ces médicaments peuvent avoir des effets indésirables, ayant un impact sur la qualité de vie des patients, et nécessitent une attention de la part des professionnels de la santé impliqués dans le traitement. Seront révisés les effets indésirables suivants : hypogonadisme masculin, allongement du QT, sevrage néonatal, anomalies des fonctions respiratoires, hyperalgésie, risque d’intoxication, abus de la médication, interactions médicamenteuses. À ces effets pharmacologiques viennent s’ajouter des contraintes réglementaires, qui, si elles peuvent être pertinentes en début de traitement, s’avèrent lourdes et inadaptées pour les patients stables depuis plusieurs années. De l’écoute et une bonne gestion de ces effets indésirables sont indispensables pour améliorer l’acceptabilité du traitement et son attrait pour les usagers.

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High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome

Cited by 62 publications

References 15 publications

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Drugs, Alcohol, and Pregnant Women: Anesthetic Implications for Mother and Newborn

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

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