Methadone maintenance in pregnancy: A reappraisal

Methadone maintenance program in a Swiss perinatal center: (I): Management and outcome of 89 pregnancies

“…Fluctuating street heroin blood levels with drug withdrawal in the mother have long been known to be associated with fetal distress (13,14), while cocaine may cause vascular disruptive events (11,15). Following other authors (6,9–11), we confirm the high incidence of additional heroin and/or cocaine use (64%) and question the efficacy of methadone maintenance in terms of a key stated objective. Nor can additional drug abuse be excluded in the patients whose urine tested negative, as visit compliance and readiness to supply a urine sample are notoriously erratic in the opiate addicts.…”

“…There are different opinions on whether reduction of the methadone dose towards term has a positive impact on neonatal birthweight and withdrawal (4,9,16–19).…”

“…However, it remains unclear whether the benefits of methadone maintenance derive from the substance itself or from the pregnant woman's inclusion in a supportive program. In addition, methadone's side‐effects include a more severe neonatal withdrawal syndrome than after heroin exposure in utero (8), and a lower birthweight and head circumference than in nondrug users (6,9,10). Illicit drug abuse also remains common among women in methadone programs (6,9–11), indicating that the ideal maintenance substance in pregnancy has yet to be found.…”

Management of neonatal abstinence syndrome: a national survey and review of practice

“…Polysubstance use is widespread in this population. Benzodiazepine use and cocaine abuse occur in 50%17 and 37%18 of pregnant women on methadone, respectively, with the latter in particular increasing the frequency and severity of withdrawal 19…”

Treatment of neonatal abstinence syndrome

“…Barbiturate use (prescribed and illicit) during pregnancy can also result in withdrawal symptoms sufficiently severe to require treatment. 12 13 One third of methadone users have been reported to take cocaine, 14 which is known to have significant vasoconstrictive effects on the developing brain, 15 leading to neurological abnormalities. 16 17 Cocaine use alone does not cause NAS; abstinence scores, however, were significantly higher in infants exposed to both cocaine and diamorphine than in those exposed to diamorphine alone.…”