Home > Methadone and perinatal outcomes – a prospective cohort study.

Cleary, Brian J and Eogan, Maeve and O’Connell, MP and Fahey, Tom and White, Martin J and McDermott, C and O'Sullivan, A and Carmody, Deirdre and Gleeson, J and Murphy, Deidre J (2012) Methadone and perinatal outcomes – a prospective cohort study. Addiction, 107, (8), pp. 1482-1492. DOI: 10.1111/j.1360-0443.2012.03844.x.

Aims: Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to i)concomitant drug use and ii)methadone dose.

Design: Prospective cohort study.
Setting: Two tertiary care maternity hospitals.
Participants: 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010.

Measurements: Information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included preterm birth (<37 weeks’ gestation), small for gestational age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalisation.

Findings: Of the 114 liveborn infants 11 (9.6%) were born preterm, 49 (42.9%) were small for gestational age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%) were medically treated for NAS. Neonates exposed to methadone only had a shorter hospitalisation than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, p = 0.03). Neonates exposed to methadone doses ≥80mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3mg, p = 0.03). The incidence and duration of NAS did not differ between the two dosage groups.

Conclusion: The incidence and duration of the neonatal abstinence syndrome is not associated with material methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalisation.

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