Advertisement

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

  • Dykes Maxwell YoungEmail author
Article

Abstract

Conventional wisdom regarding management of opioid dependence in pregnancy calls for methadone maintenance in nearly all cases. The scientific literature and historical background upon which this recommendation is based, newer evidence indicating the safety of methadone discontinuation during pregnancy and recent studies raising concerns about the effects of methadone on the fetus and neonate are reviewed. More flexibility in the management of opioid dependence during pregnancy is recommended.

Keywords

Opioid dependence Pregnancy Detoxification Neonatal abstinence syndrome Microcephaly Congenital malformation Relapse Methadone MMT Methadone maintenance Prescription opioids Heroin Residential treatment Abstinence 

References

  1. American Academy of Pediatrics. (1998). Neonatal drug withdrawal. Pediatrics, 101, 1079–1088.CrossRefGoogle Scholar
  2. Arlettaz, R., Kashiwagi, M., Das-Kundu, S., Fauchiere, J. C., Lang, A., & Bucher, H. U. (2005). Methadone maintenance program in pregnancy in a Swiss perinatal center (II): Neonatal outcome and social resources. Acta Obstetrica et Gynecologica Scandinavica, 84, 145–150.CrossRefGoogle Scholar
  3. Berghella, V., Lim, P. J., Hill, M. K., Cherpes, J., Chennat, J., & Kaltenbach, K. (2003). Maternal methadone dose and neonatal withdrawal. American Journal of Obstetrics and Gynecology, 189, 312–317.PubMedCrossRefGoogle Scholar
  4. Brown, H. L., Britton, K. A., Mahaffey, D., Brezendine, E., Hiett, A. K., & Turnquest, M. A. (1998). Methadone maintenance in pregnancy: A reappraisal. American Journal of Obstetrics and Gynecology, 179, 459–463.PubMedCrossRefGoogle Scholar
  5. Dashe, J. S., Jackson G. L., Olscher, D. A., Zane, E. H., & Wendel, G. D. (1998). Opioid detoxification in pregnancy. Obstetrics & Gynecology, 92, 854–858.CrossRefGoogle Scholar
  6. Dashe, J. S., Sheffield, J. S., Olscher, D. A., Todd, S. J., Jackson, G. L., & Wendel, G. D. (2002). Relationship between maternal methadone dosage and neonatal withdrawal. Obstetrics & Geynecology, 100, 1244–1249.CrossRefGoogle Scholar
  7. Harper, R. G., Solish, G. I., Purow, H. M., Sang, E., & Panepinto, W. C. (1974). The effect of a methadone treatment program upon pregnant heroin addicts and their newborn infants. Pediatrics, 54, 300–305.PubMedGoogle Scholar
  8. Hartman, G. E. (2004). Diaphragmatic hernia. In R. E. Behrman, R. M. Kliegman, & H. B. Jenson (Eds.), Nelson: Textbook of Pediatrics, 17th ed. (p. 353) Philadelphia, PA: Saunders.Google Scholar
  9. Herman, H. J., Ratcliff, S., & Langrod, J. (2000). Methadone maintenance treatment (MMT): A review of historical and clinical issues. Mt Sinai Journal of Medicine, 6, 347–364.Google Scholar
  10. Hubbard, R. L., Craddock, S. G., & Anderson, J. (2003). Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS). Journal of Substance Abuse Treatment, 25, 125–134.PubMedCrossRefGoogle Scholar
  11. Hulse, G. K., Milne, E., English, D. R., & Holman, C. D. (1997). The relationship between maternal use of heroin and methadone in infant birth weight. Addiction, 92, 1571–1579.PubMedCrossRefGoogle Scholar
  12. Jansson, L. M., DiPietro, J., & Elko, A. (2005). Fetal response to maternal methadone administration. American Journal of Obstetrics and Gynecology, 193, 611–617.PubMedCrossRefGoogle Scholar
  13. Johnson, K., Greenough, A., & Gerada, C. (2003). Maternal drug use and length of neonatal stay. Addiction, 98, 758–789.Google Scholar
  14. Kashiwagi, M., Arlettaz, R., Lauper, U., Zimmerman, R., & Hebisch, G. (2005). Methadone maintenance program in a Swiss perinatal center. I. Management and outcome of 89 pregnancies. Acta Obstetricia et Gynecologica Scandinavica, 84, 140–144.PubMedCrossRefGoogle Scholar
  15. Luty, J., Nikolaou, V., & Bearn, J. (2003). Is opiate detoxification unsafe in pregnancy? Journal of Substance Abuse Treatment, 2, 363–367.CrossRefGoogle Scholar
  16. Markham, J. K., Emmerson, J. L., & Owen, N. V. (1971). Teratogenicity studies of methadone HCl in rats and rabbits. Nature, 233, 342–343.PubMedCrossRefGoogle Scholar
  17. McCarthy, J. J., Lemon, M. M., Parr, M. S., & Anania, B. (2005) High-dose methadone maintenance in pregnancy: Maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 193, 606–610.PubMedCrossRefGoogle Scholar
  18. Miller, J. (1998).Treatment of the addicted woman in pregnancy. In A. W. Graham & T. K. Schultz (Eds.), Principles of addiction medicine 2nd ed. (pp. 1206–1207). Chevy Chase: American Society of Addiction Medicine.Google Scholar
  19. Nijhuis, J. (2003). Fetal behavior. Neurobiology of Aging, S11, S41–S46.CrossRefGoogle Scholar
  20. Rementeria, J. L., & Nunag, N. N. (1973). Narcotic withdrawal in pregnancy: stillbirth incidence with a case report. American Journal of Obstetrics and Gynecology, 116, 152–156.Google Scholar
  21. Rosenbaum, M. (1997). Substance abuse, a comprehensive textbook (3rd ed.) Baltimore, MD: Williams and Wilkins.Google Scholar
  22. Sinha, C., Ohadike, P., Carrick, P., Pairaudeau, P., Armstrong, D., & Lindow, S. W. (2001). Neonatal outcome following maternal opiate use in late pregnancy. International Journal of Gynecology and Obstetrics, 74, 241–246.PubMedCrossRefGoogle Scholar
  23. Zuspan, F. P., Gumpel, J. A., Mejia-Zelaya, A., Madden, J., & Davis, R. (1975). Fetal stress from methadone withdrawal. American Journal of Obstetrics and Gynecology, 22, 43–46.Google Scholar
  24. Zweben, J. E., Aly, T., Martin, J., Wengrofsky, S., Bacci, J., & Meddaugh, R. (1999). Making residential treatment available to methadone clients. Journal of Substance Abuse Treatment, 17, 249–256.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Chemical Dependency TreatmentKaiser PermanenteSan FranciscoUSA

Personalised recommendations