Home > Maintenance agonist treatments for opiate dependent pregnant women.

Minozzi, Silvia and Amato, Laura and Jahanfar, Shayesteh and Bellisario, Cristina and Ferri, Marica and Davoli, Marina (2020) Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database of Systematic Reviews, (11), Art. No.: CD006318. DOI: 10.1002/14651858.CD006318.pub4.

External website: https://www.cochranelibrary.com/cdsr/doi/10.1002/1...

Some women continue to use opiates when they are pregnant, yet heroin readily crosses the placenta. Opiate-dependent women experience a six-fold increase in maternal obstetric complications and give birth to low-weight babies. The newborn may experience narcotic withdrawal (neonatal abstinence syndrome) and have development problems. There is also increased neonatal mortality and a 74-fold increase in the risk of sudden infant death syndrome. Maintenance treatment with methadone provides a steady concentration of opiate in the pregnant woman's blood and so prevents the adverse effects on the fetus of repeated withdrawals. Buprenorphine is also used. These treatments reduce illicit drug use, improve compliance with obstetric care and improve neonatal birth weight but they are still associated with neonatal abstinence syndrome.

This review found few differences in newborn or maternal outcomes for pregnant, opiate-addicted women who were maintained on methadone, buprenorphine or oral slow-release morphine from a mean gestational age of 23 weeks to delivery. Only four randomised controlled trials with 271 participants trials satisfied the inclusion criteria for the review: two from Austria (outpatients), one from the USA (inpatients) and the fourth a multi-centre, international study conducted in Austria, Canada and the USA. The trials continued for 15 to 18 weeks. Three compared methadone with buprenorphine (223 participants) and one compared methadone with oral slow-release morphine (48 participants). The number of women who dropped out from treatment was lower in the methadone group. However, there was no difference in the use of primary substance between the methadone and buprenorphine groups. The number of newborns treated for neonatal abstinence syndrome did not differ significantly between groups. Birth weight was higher in the buprenorphine group in two trials and no different in the third. Oral slow-release morphine seemed superior to methadone in terms of the number of women who used heroin in their third trimester. However, there was no clear improvement in infant birth weight or duration of neonatal abstinence syndrome. The number of participants in the trials was small and may not be sufficient to draw firm conclusions. All the included studies ended immediately after the baby was born. No severe complications were noted.

Item Type
Publication Type
International, Review, Article
Drug Type
Intervention Type
Drug therapy, Treatment method
November 2020
Identification #
Art. No.: CD006318. DOI: 10.1002/14651858.CD006318.pub4
John Wiley & Sons, Ltd
Place of Publication
John Wiley & Sons, Ltd
Accession Number
HRB (Electronic Only)

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