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

Abstract

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.

Management of Opioid Dependence in Pregnancy: A Review of the Evidence

“…In summary, while discontinuation of MMT poses a risk of relapse to illicit drug use, use of illicit drug use is nevertheless high in pregnant recipients of MMT. Kashiwagi et al (2005) found no association between birth weight and last maternal methadone dose. Newborns of exclusive or near exclusive methadone users when compared to polydrug users showed significantly higher birth weights: 2,905 vs. 2511 g (p=0.0002), confirming the conclusion of Hulse et al (1997) that concurrent illicit drug use reverses the benefits of MMT.…”

“…In Dashe et al (1998), 50% of the subjects successfully maintained abstinence. In Kashiwagi et al (2005), 45% of the subjects maintained a drug-free state through delivery. Since residential treatment outcomes in preventing relapse to illicit drug use are comparable to MMT in select opiate users (Hubbard, Craddock & Anderson, 2003), it is noteworthy that none of the women in these two studies entered residential treatment, or received chemical dependency treatment other than medical detoxification.…”

Substance use in pregnancy

“…Recent studies have failed to show any significant increased rates of obstetrical complications following opioid detoxification [91,93,94,101]. Regardless, opioid detoxification is not advisable during pregnancy primarily because of the high rate of relapse [102][103][104][105][106]. Opioid detoxification should be performed only after the first trimester and with informed consent based on a discussion of the potential risks and benefits.…”

Polydrug use during pregnancy and neonatal outcome: Data from a ten-year retrospective French study

“…A recent Australian study took opiate and amphetamine use among mothers into account, but not alcohol, cannabis or cocaine (McGlade et al, 2009). The most recent cohorts show a generalisation of polydrug use, which also involves pregnant women (Kashiwagi et al, 2005;Mayet et al, 2008aMayet et al, , 2008bPinto et al, 2010).…”