Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome

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

“…36 Previous studies investigating the influence of prescribed maternal methadone dose upon the development of NAS have yielded conflicting results. 9,[13][14][15][16][17][18][19] The largest of these studies included 100 infants. 15 Other studies have spanned more than a decade and been confounded by cocaine and heroin use.…”

“…[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.…”

Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates

“…In fact methadone trough levels do not correlate well with maternal dosage (24), so that maternal methadone dose should be decided based on maternal symptoms, with no predetermined maximum. Positive results may also be achieved in women who undergo supervised withdrawal to doses less than 20 mg daily (8,10). Split daily dosing may be another alternative to maintain plasma methadone levels at lower overall doses (25,26).…”

“…Initiating pharmacologic treatment for NAS decreases the duration of symptoms (2) but does not subjugate the necessity to decrease the severity of withdrawal through antenatal interventions. The majority of literature on methadone administration is concentrated on dosage and the findings regarding an association between maternal methadone dose and the severity of neonatal withdrawal conflict (6,8,9,10,11,12,13,14,15). The optimal dose remains a topic of clinical debate.…”

Neonatal Drug Withdrawal

“…Some studies demonstrated that larger maternal methadone dosages in late pregnancy were associated with greater neonatal concentrations and increased risk of withdrawal, 8,9,[62][63][64][65][66][67][68] but others refuted a correlation. [69][70][71][72][73][74] This lack of consensus is explained in part by different approaches to the management of antenatal methadone maintenance therapy.…”