Fetal stress from methadone withdrawal

Zuspan, Frederick P.; Gumpel, Janis A.; Mejia-Zelaya, Alfonso; Madden, John D.; Davis, Roy

doi:10.1016/0002-9378(75)90613-4

Cited by 138 publications

(50 citation statements)

References 3 publications

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“…[4,5] This view is largely the result of two influential case reports published in the 1970s. Rementeria and Nunag [5] described a stillbirth at term following acute methadone withdrawal, and Zuspan et al [18] described a case of increased amniotic fluid epinephrine levels during methadone withdrawal, which resolved once the methadone dose was increased.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…The authors therefore caution against methadone withdrawal in the third trimester. Fetal stress from methadone withdrawal Zuspan et al [18] American Journal of Obstetrics and Gynecology, 1975 Description of one patient who developed increased amniotic fluid epinephrine levels while undergoing methadone withdrawal. The authors recommend avoiding detoxification.…”

Section: Researchmentioning

confidence: 99%

See 1 more Smart Citation

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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Section: Systematic Reviewmentioning

confidence: 99%

Section: Researchmentioning

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

View full text Add to dashboard Cite

show abstract

“…The stress state that characterizes withdrawal may also have a negative impact on the fetus; some studies show increased epinephrine in amniotic fluid. 39 Neonatal abstinence syndrome from opioids has been well-characterized and may last up to 10 weeks following delivery and require management in an intensive care unit. Neonatal abstinence syndrome involves wakefulness, irritability, tremulousness, and temperature dysregulation, as well as a disorganized suck and subsequent failure to thrive.…”

Section: What Is the Epidemiology Of Opioid Use During Pregnancy Andmentioning

confidence: 99%

Cocaine and Opioid Use During Pregnancy: Prevalence and Management

Bhuvaneswar¹,

Chang²,

Epstein³

et al. 2008

Prim. Care Companion J. Clin. Psychiatry

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“…Accounts appeared in the obstetric and pediatric literature of stillbirth and fetal compromise associated with maternal withdrawal from narcotics.36 Obstetricians voiced concern about detoxification during pregnancy unless biochemical monitoring of fetal status could be assured. 37 Clinicians then disagreed about optimal dosage for methadone maintenance. Several investigators reported correlations between maternal methadone dose and the severity of neonatal withdrawal symptoms and concluded that maternal methadone dose should be decreased to less than 20 mg/day as early in gestation as possible.38,39 Other investigators, however, did not confirm a straightforward relationship between maternal dose and the severity of the neonatal abstinence syndrome.…”

Section: Medical Management and Uncertaintymentioning

confidence: 99%