Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources

Abstract

Babies born to women on methadone had a fourfold higher incidence of prematurity, a ninefold higher incidence of intrauterine growth retardation (IUGR), and a fourfold higher incidence of microcephaly compared with the normal population. Sixty-two percent required pharmacological treatment for abstinence syndrome and 42% required placement.

Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

“…Even with specialist multidisciplinary antenatal care 31 and good maternal compliance during pregnancy, these infants are of low birthweight and at increased risk of preterm delivery. 2,6,8 The stillbirth rate of 1.3% was almost double that seen in the hospital as a whole, although the incidence of congenital abnormality was not increased. 32 Undoubtedly, the effects of drug misuse upon the unborn child are confounded by social deprivation and maternal health and lifestyle.…”

“…2,3,7,8,27,28 In a recent survey, only 55% of NNUs had a written policy for management of NAS. 33 We defined NAS by a requirement for pharmacological treatment, commenced according to a reasonably strict local policy incorporating the Lipsitz scoring system as recommended by the American Academy of Pediatrics.…”

“…2 Substitute prescribing of methadone stabilises lifestyle and reduces risk-taking behaviour as well as the incidence of preterm birth and intrauterine growth restriction [3][4][5][6] but is commonly associated with NAS. [6][7][8][9] Preterm infants may be less likely than term infants to exhibit signs of NAS resulting from opiate or opioid exposure. [10][11][12] There is conflicting evidence with regard to optimal maternal methadone dose in pregnancy, with some studies showing an association between maternal methadone dose and the risk of NAS and some studies showing no such relationship.…”

“…9,[13][14][15][16][17][18][19] Duration of stay may be longer for infants born to polydrug-misusing mothers, 20 and since higher doses of methadone have been associated with less polydrug use, reducing methadone during pregnancy may not be justified. 13 Australian and European data have demonstrated large consumption of healthcare resources by infants born to drug-misusing women, 2,8 but there are few data to quantify this within the UK healthcare setting. [20][21][22] We present data from infants born over a 3-year period to a large cohort of drug-misusing mothers cared for by a specialist service within a large inner-city maternity hospital in the UK.…”

Breastfeeding and Methadone Therapy: The Maternal Experience

“…1,2 Breastfeeding may have additional benefits for women taking methadone and their infants, including decreased occurrence or severity of neonatal abstinence syndrome (NAS) [3][4][5] and improvement of familial social functioning through stress reduction, increased maternal confidence, and enhanced mother-infant bonding associated with a positive breastfeeding experience. 6 It is plausible that breastfeeding may also prolong the substance-free period in methadone-exposed women, owing to the known risks of illicit drug transfer through breast milk.…”