The management of heroin misuse in pregnancy: time for a rethink?

Mactier, Helen

doi:10.1136/adc.2009.181057

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…Substitute methadone is currently the recommended treatment for pregnant opioid-dependent women,1 4 with advantages for mother and baby including stabilisation of maternal lifestyle and reduced incidence of IUGR 2–4. The disadvantages of methadone use during pregnancy include an increased incidence of NAS3 4 and likely detrimental effects upon infant visual development 5–9 12.…”

Section: Discussionmentioning

confidence: 99%

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Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy

et al. 2013

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Section: Discussionmentioning

confidence: 99%

“…The disadvantages of methadone use during pregnancy include an increased incidence of NAS3 4 and likely detrimental effects upon infant visual development 5–9 12. The latter has been reported only relatively recently, mostly in small case series, and has not been properly quantified to date 5–7 9 12.…”

Section: Discussionmentioning

confidence: 99%

Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy

et al. 2013

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“…This hypothesis is supported by results from preclinical studies that point towards alterations not only in dopaminergic but also in catecholaminergic [37] neurotransmission caused by opioid exposure in utero. Studies controlled for environmental factors (including social deprivation and affection of the parent-child-interaction due to neonatal withdrawal symptoms [38]) link opioid exposure in utero with worse performance in intelligence testing and with high incidences of psychiatric disease [5]. …”

Section: Intrauterine Exposure To Alcohol/opioidsmentioning

confidence: 99%

“…Some differences were found, however, on fetal head growth, suggesting that fetuses exposed to methadone may be at higher risk for stunted head growth as compared to those exposed to buprenorphine. However, these studies were not controlled for potential bias such as concurrent drug or nicotine use or social differences, which may reduce the generalizability of the results [5, 73, 75]. The main reason for preferring buprenorphine over methadone is the relatively mild neonatal withdrawal syndrome (NWS) in neonates exposed to buprenorphine in utero [76–78].…”

Section: The Treatment Of Alcohol/opioid-dependent Pregnant Womenmentioning

confidence: 99%

“…The European Monitor Centre for Drugs and Drug Addiction reports that about half a million of opioid-dependent Europeans are in opioid maintenance therapy (OMT) [2] and that in Europe, around 30.000 opioid-dependent women get pregnant [3]. Although, moderate alcohol consummation during pregnancy has not been associated with deleterious fetal effects [4], alcohol and/or opioid use disorders during pregnancy carries several risks such as fetal alcohol syndrome (FAS), spontaneous abortion, intrauterine growth restriction, antepartum hemorrhage, preterm delivery, and stillbirth [5]. Proven treatment options regarding alcohol and opioid dependence are limited owing to the complexity of substance dependence and the lack of data from randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

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The treatment of alcohol and opioid dependence in pregnant women

Heberlein

Leggio

Stichtenoth

et al. 2012

Current Opinion in Psychiatry

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Purpose of the review This article addresses the question of “best treatment options,” which clinicians face when treating pregnant women with alcohol and/or opioid dependence. Recent findings Alcohol Studies show that alcohol consumption is associated with fetal abnormalities and long-term cognitive problems depending on amount consumed, drinking pattern, and time of gestation. Screening and evaluation of specific interventions are important to reduce alcohol consumption during pregnancy and associated problems in infants. Opioids Withdrawal-induced fetal distress and the risk of relapse are the primary reasons why opioid detoxification is only recommended in the second or third trimesters and only in those pregnant women who refuse opioid maintenance therapy (OMT). Methadone is the most established treatment of pregnant opioid-dependent women, but recent investigations suggest that substitution with buprenorphine may have advantages over methadone in terms of neonatal abstinence syndrome (NAS). Promising results have been also reported for slow-release oral methadone and the heroin equivalent diamorphin. Summary Data regarding the pharmacological treatment of alcohol abuse and/or dependence is limited in pregnant women. So far, benzodiazepines seem to be the most recommendable option for managing alcohol withdrawal, and psychosocial interventions succeed in reducing alcohol consumption or in maintaining abstinence in alcohol-dependent pregnant women. Recent data, albeit preliminary, support the use of naltrexone in the treatment of alcohol-dependent pregnant women. Regarding opioid dependence meta-analyses do not clearly support the superiority of one substitute over the other during pregnancy owing to the presence of interfering factors (such as illicit drug use) in the studies conducted. Current results suggest that factors like the health status of the mother, the need for additional medications (e.g. treatment for HIV), comorbid drug dependence, and concurrent drug use need to be considered in order to find the “best opioid substitute”. Further considerations include the expectant mother’s compliance level to the treatment and the degree to which she tolerates the respective substitute.

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Buprenorphine Use in Pregnant Opioid Users: A Critical Review

Soyka

2013

CNS Drugs

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Pregnancy in opioid users poses a number of problems to treating physicians. Most guidelines recommend maintenance treatment to manage opioid addiction in pregnancy, with methadone being the gold standard. More recently, buprenorphine has been discussed as an alternate medication. The use and efficacy of buprenorphine in pregnancy is still controversial. This article reviews the current database on the basis of a detailed and critical literature search performed in MEDLINE (206 counts). Most of the relevant studies (randomised clinical trials and one national cohort sample) were published in the last 2 years and mainly compared buprenorphine with methadone. Some studies are related to maternal outcomes, others to foetal, neonatal or older child outcomes. With respect to maternal outcomes, most studies suggest that buprenorphine has similar effects to methadone. Very few data from small studies discuss an effect of buprenorphine on neurodevelopment of the foetus. Neonatal abstinence syndrome is common in infants of both buprenorphine- and methadone-maintained mothers. As regards neonatal outcomes, buprenorphine has the same clinical outcome as methadone, although some newer studies suggest that it causes fewer withdrawal symptoms. Since hardly any studies have investigated the combination of buprenorphine with naloxone (which has been suggested to possibly have teratogenic effects) in pregnant women, a switch to buprenorphine monotherapy is recommended in women who become pregnant while receiving the combination product. These novel findings indicate that buprenorphine is emerging as a first-line treatment for pregnant opioid users.

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The management of heroin misuse in pregnancy: time for a rethink?

Cited by 13 publications

References 38 publications

Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy

Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy

The treatment of alcohol and opioid dependence in pregnant women

Buprenorphine Use in Pregnant Opioid Users: A Critical Review

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