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.
Similar content being viewed by others
References
American Academy of Pediatrics. (1998). Neonatal drug withdrawal. Pediatrics, 101, 1079–1088.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Jansson, L. M., DiPietro, J., & Elko, A. (2005). Fetal response to maternal methadone administration. American Journal of Obstetrics and Gynecology, 193, 611–617.
Johnson, K., Greenough, A., & Gerada, C. (2003). Maternal drug use and length of neonatal stay. Addiction, 98, 758–789.
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.
Luty, J., Nikolaou, V., & Bearn, J. (2003). Is opiate detoxification unsafe in pregnancy? Journal of Substance Abuse Treatment, 2, 363–367.
Markham, J. K., Emmerson, J. L., & Owen, N. V. (1971). Teratogenicity studies of methadone HCl in rats and rabbits. Nature, 233, 342–343.
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.
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.
Nijhuis, J. (2003). Fetal behavior. Neurobiology of Aging, S11, S41–S46.
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.
Rosenbaum, M. (1997). Substance abuse, a comprehensive textbook (3rd ed.) Baltimore, MD: Williams and Wilkins.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Young, D.M. Management of Opioid Dependence in Pregnancy: A Review of the Evidence. Int J Ment Health Addiction 5, 187–194 (2007). https://doi.org/10.1007/s11469-007-9054-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-007-9054-z