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Heroin Addiction and Related Clinical Problems: 2018, 20, N2 (pages: 5 - 11)

Methadone Dose as a Determinant of Infant Outcome During the Peri and Postnatal Period

Wang M., Stapleton J., and Wolff K.

Summary: Background: Methadone remains the mainstay pharmacotherapy for heroin dependent women across Europe although treatment is not standard and neonatal outcomes vary. Aim: We studied pregnant opioid dependent women to compare outcomes during the peri- and postnatal period in infants exposed to methadone in utero. We hypothesized that doses <30 mg methadone/day would contribute to poorer infant outcomes when compared to doses ≥30 mg methadone/day. Methods: A retrospective case note study of methadone maintained mother and infant pairs were evaluated. Cases from an inner city Specialist NHS Substance Misuse Service were categorized according to the methadone dose received at delivery: ≤ 30 mg (detoxification dose) or >30 mg methadone/day. Infant outcomes included gestation, birth weight, and mode of delivery, prevalence of Neonatal Withdrawal Syndrome (NAS) and parenting. Results: Nearly twice as many infants in the ‘≤ 30 mg' group were treated for NAS (40% Vs 22.7% respectively). Mothers in the >30 mg' group were significantly more likely to use; crack cocaine (59.1% Vs 20%, p < 0.044); drugs by the intravenous route (49.1% Vs 6.7%, p < 0.054) and; be referred to Social Services (100% Vs 73%, p < 0.043). Half of their infants were placed under protective care. Conclusions: Our study suggests differences in outcomes for infants according to the maternal dose at delivery. More detailed assessment during pregnancy and in the perinatal period of the addict lifestyle may be crucial in optimising neonatal outcomes. Further research is needed in this area.