Methadone Maintenance vs. Methadone Taper During Pregnancy: Maternal and Neonatal Outcomes

Jones, Hendrée E.; O’Grady, Kevin E.; Malfi, Debbie; Tuten, Michelle

doi:10.1080/10550490802266276

Cited by 164 publications

(177 citation statements)

References 43 publications

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“…39 Among the five retrospective case series involving women with heroin addiction, there is no consensus on the rate of methadone taper or the superiority of inpatient versus outpatient detoxification (Box 4). [40][41][42][43][44] Although the literature cites concerns for increased rates of miscarriage with detoxification during the first trimester and increased rates of preterm labour with detoxification during the third trimester, 45,46 this effect was not shown. 40,43 Neonatal outcomes, when reported, were inconsistent.…”

Section: Is There a Role For Detoxification In Pregnancy?mentioning

confidence: 87%

“…In this regard, the literature suggests that postpartum treatment is generally not provided to women in rural and remote communities, which contributes to high rates of relapse and apprehension of infants into custody. 2,13,44 Despite knowledge of harm and rising rates of opioid dependence in pregnancy, there is a paucity of high-quality evidence in this area and none that specifically addresses the needs of rural and remote communities or Aboriginal communities, polysubstance use or postpartum management. There is an overwhelming need for training in opioid dependence therapy, regulatory changes to ensure pregnant women have access to appropriate medications and greater access to comprehensive treatment both during pregnancy and postpartum in rural and remote settings.…”

Section: Resultsmentioning

confidence: 99%

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The management of opioid dependence during pregnancy in rural and remote settings

Jumah

Graves

2014

CMAJ

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• Nonmedical use of prescription opioids during pregnancy is becoming more common, and members of Canada's Aboriginal population are disproportionately affected.• Methadone maintenance therapy has logistic limitations in rural and remote settings, but buprenorphine and slow-release morphine maintenance therapies are feasible alternatives.• Opioid detoxification in pregnancy is associated with high rates of relapse and should only be offered if a comprehensive rehabilitation program is available.• Treatment of opioid dependence and rehabilitation services should be provided to all women during pregnancy and the postpartum period.

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Section: Is There a Role For Detoxification In Pregnancy?mentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

The management of opioid dependence during pregnancy in rural and remote settings

Jumah

Graves

2014

CMAJ

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“…64% continued to use illicit substances while in programme. Methadone maintenance v. methadone taper during pregnancy: Maternal and neonatal outcomes Jones et al [11] American Journal on Addictions, 2008 175 opioid-dependent pregnant women given methadone maintenance, methadone withdrawal alone, or withdrawal followed by maintenance. Given the poor maternal outcomes with withdrawal alone, maintenance should be considered as the primary treatment approach.…”

Section: Systematic Reviewmentioning

confidence: 99%

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Gilfillan¹,

Dannatt

Stein

et al. 2018

S Afr Med J

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Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector. Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010. Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files. Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery. Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study.

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“…Research pertaining to the effectiveness of methadone during pregnancy has been wide ranging but rarely systematic (Jones, O'Grady, Malfi, & Tuten, 2008). Ethical considerations coupled with cost have severely restricted the number of investigations that adequately covers the pre-, peri-and post-natal periods (Wolff, Boys, Rostami-Hodjegan, Hay, & Raistrick, 2005).…”

Section: Introductionmentioning

confidence: 99%

A National Survey Investigating Methadone Treatment for Pregnant Opioid Dependent Women in England and Wales

Perez-Montejano

Finch

Wolff

2013

Int J Ment Health Addiction

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We investigated the management and treatment of pregnant opioid users by Drug Treatment Services by region across England and Wales. A postal survey was conducted among 223 Community Drug Treatment Services (CDTS) across England and Wales. Sixtysix percent CDTS responded (n=154/233) to the survey. Over half CDTS (55.3%) provided a maintenance methadone dose lower than that recommended for non-pregnant drug users.There were significant variations across regions and how professionals approached the management of pregnant opioid users. CDTS with an addiction specialist were significantly more likely (p<.01) to advocate high doses of methadone whereas those with a midwife, obstetrician or social worker involved were more likely (p<.05) to suggest low dose methadone and/or detoxification. Service provision for pregnant opioid users is reliable and comprehensive but there is still variability in some aspects of the treatment received and the way in which methadone is prescribed is not always optimal.

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Methadone Maintenance vs. Methadone Taper During Pregnancy: Maternal and Neonatal Outcomes

Cited by 164 publications

References 43 publications

The management of opioid dependence during pregnancy in rural and remote settings

The management of opioid dependence during pregnancy in rural and remote settings

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

A National Survey Investigating Methadone Treatment for Pregnant Opioid Dependent Women in England and Wales

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