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

Abstract

Background. Although methadone maintenance is the standard treatment of opiate addiction in pregnancy, opinion as to its utility is divided. The aim of this study was to analyze polydrug abuse, pregnancy outcome and fetomaternal complications among pregnant women in a major Swiss methadone maintenance program. Methods. Prospective data collection of all pregnant opiate addicts and their neonates from 1996 to 2001. Results. Maternal complications occurred in 73% and fetal complications in 34% of the pregnancies. The average methadone dose at delivery in the 89 pregnancies was 40.9 AE 32.7 (0-150) mg/day. Sixty-four percent of the women were co-users of cocaine and/or heroin. Birthweight was lower in polydrug abusers than in near-exclusive methadone users (p ¼ 0.001). Conclusion. The high rate of maternal complications demonstrates the need for further improvement in antenatal management of opiate addiction in pregnancy. Methadone maintenance is inefficient in preventing pregnancy exposure to additional illicit drug consumption. Additional illicit heroin and/or cocaine abuse does not seem to increase the incidence of fetomaternal complications during pregnancy, but reverses the positive impact of methadone on birthweight. Heroin-assisted treatment may be a more effective method of minimizing the use of street drugs.

Effects of Prenatal Cocaine Exposure on Human Pregnancy and Postpartum

“…Methadone is the standard therapy for pregnant opioid-dependent women [84]. The positive effects of methadone are an increase in birth weight and prolongation of gestation [85,86]. Because co-consumption of methadone with other drugs such as cocaine and heroin is frequent, additional drugs may influence the placental transfer of methadone and other substances by different mechanisms.…”

Cocaine and Opioid Use During Pregnancy: Prevalence and Management

“…Conversion is associated with fewer spontaneous abortions as well as a reduced risk of intravenously transmitted infections. 43 It has been estimated that there is a rate of 3% to 4% of spontaneous abortion with methadone (and possibly with buprenorphine maintenance) 44,45 compared with a rate of 10% to 20% in women who continue to use heroin; this higher rate is attributed to wide variations in level of opiates and resulting fetal stress. 46 In making the conversion to methadone, the starting dose often ranges from 1 to 20 mg; patients are then dosed on an asneeded basis for signs and symptoms of opiate withdrawal (including subjective cravings) every 6 hours, with most patients reaching a stable dose after 48 to 72 hours.…”

“…53 Perhaps the only finding that may argue for a highly selective inclusion of pregnant women in methadone maintenance is that increased neonatal mortality has been associated with women who relapse to heroin while taking methadone, as compared with women using heroin alone. 45 Buprenorphine as an alternative to methadone in pregnancy has been validated by several naturalistic studies in France, where outpatient physicians can treat with buprenorphine without specialized training; up to 70,000 patients annually have received the medication on an outpatient basis since the 1996 liberalization of policies. 54 Though several French and some American studies report positive findings for buprenorphine in pregnancy, 55,56 greater severity of the neonatal abstinence syndrome and higher rates of sudden infant death were described in 1 Finnish study.…”

“…46 In making the conversion to methadone, the starting dose often ranges from 1 to 20 mg; patients are then dosed on an asneeded basis for signs and symptoms of opiate withdrawal (including subjective cravings) every 6 hours, with most patients reaching a stable dose after 48 to 72 hours. 45 Cultural and psychological barriers among this population to using methadone should be addressed. Women in early recovery may be resistant to being "on drugs" again.…”

Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

“…For instance, the majority of women in OMT continue to smoke during pregnancy, thus most children of mothers in OMT are prenatally exposed to nicotine (Jones et al, 2009), which may impair children's development by affecting cells in the hippocampus and somatosensory cortex (Castellanos & Tannock, 2002). Among pregnant women in OMT, a large proportion continues to use illicit drugs such as heroin, cocaine, or benzodiazepines during pregnancy (Kashiwagi, Arlettaz, Lauper, Zimmermann, & Hebisch, 2005;McCarthy, Leamon, Parr, & Anania, 2005). These drugs may have a negative effect on brain development, behavior, and cognition (Moe, 2002;Slinning, 2004;Walhovd et al, 2007).…”