A Comprehensive Care Program for Pregnant Addicts: Obstetrical, Neonatal, and Child Development Outcomes

Abstract

This study reports the results of a comprehensive care program for pregnant addicts, one that provides medical, counseling, and child development services. Findings include the following. Women who enroll while pregnant generally stay through childbirth, and most deliveries are free of complication. Most newborns are of normal gestational age and birthweight, and these outcomes are directly related to length and amount of prenatal care. Neonatal withdrawal is directly related to prenatal maternal methadone dose. Child development, as measured by the Bayley Scales, is usually in the normal range, although mean scores for cognitive development decrease through age 2. Female babies generally have higher cognitive and motor scores than males, and their cognitive scores decline less sharply than those of the males. Developmental scores are directly related to neonatal maturity, especially birthweight. Prenatal maternal methadone dose tends to be negatively related to developmental scores for boys but not for girls.

Infrequent neonatal opiate withdrawal following maternal methadone detoxification during pregnancy

“…Our study confirms the high incidence of preterm deliveries (table IV) as reported in opiate addicts [1,3,18,19,23] which may be due to drug withdrawal attacks [25]. However, only one of our infants was less than 33 weeks of gestation.…”

“…The rising heroin abuse in North America in the sixties prompted comprehensive reports of neonatal opiate withdrawal [19,23,26,28]. In Europe, neonatal heroin addiction has become a problem within the last 20 years [1,3,18] demanding for professional and standardized prenatal and neonatal care.…”

“…Methadone substitution during pregnancy was attempted in order to supply pregnant addicts with better social and obstetric care. The replacement of heroin by an appropriate oral dose of methadone enhanced intrauterine growth [18,23,27,29], but increased frequency and severity of neonatal abstinence syndrome [27,29].…”

Improving treatment outcome in pregnant opiate-dependent women

“…For example, the results of a retrospective case control study comparing methadone-maintained pregnant subjects with untreated women showed that both groups used illicit substances at high rates and gave birth to infants of similar weight, although the treated women had more prenatal care (Edelin, Gurganious, Golar, Oellerich, Kyei-Aboagye, & Hamid, 1988). Conversely, Suffet and Brotman (1984) have reported that a comprehensive care program for pregnant opiate-dependent women, including medical, counseling, and child development services, resulted in improved pregnancy outcome. However, no data from a comparison group were presented.…”

Cocaine and Opioid Use During Pregnancy: Prevalence and Management

“…An early study by Chang and colleagues 51 showed that enhanced prenatal care and comprehensive services have better results than a traditional methadone program despite equivalent dose ranges for maintenance. 51,52 There is also some debate about whether higher or lower doses at delivery are of particular benefit. Lower doses are associated with less neonatal withdrawal, but higher doses during the pregnancy and at delivery are associated with better patient compliance, reduced relapse risk, and higher neonatal birthweights.…”