Dryden C, Young D, Hepburn M, et al.. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Neonatal Unit, Princess Royal Maternity, Glasgow, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 03/2009; 116(5):665-71. DOI: 10.1111/j.1471-0528.2008.02073.x
Source: PubMed

ABSTRACT The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women.
Retrospective cohort study from 1 January 2004 to 31 December 2006.
Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women.
Four hundred and fifty singleton pregnancies of drug-misusing women prescribed substitute methadone in pregnancy.
Case note review.
Development of NAS and duration of infant hospital stay.
45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34-0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7-17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days.
Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources.

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Available from: Helen Mactier, Aug 14, 2015
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    • "observational studies have found that certain unfavorable neonatal outcomes, such as growth retardation, low birth weight, preterm delivery, and neonatal abstinence syndrome [NAS], were very common (e.g., NAS: 40–75%) among the offspring of women enrolled in the opioid substitute therapy (Burns et al., 2010; Chen et al., 2015; Cleary et al., 2012; Dryden et al., 2009; Hulse et al., 1997, 1998b; Kakko et al., 2008). Relative to infants of non-drug using mothers, the needs in healthcare for children born to women on an opioid substitute therapy are expected to be higher (Johnson et al., 2003; Jones et al., 2010; Kakko et al., 2008), and as such their access to quality and regular well child services is especially important. "
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    ABSTRACT: Children of heroin-using women have a higher risk of unfavorable health and developmental outcomes. Although methadone maintenance treatment (MMT) has been widely used to treat heroin-using pregnant women, potential effects on accessibility and utilization of healthcare service for their offspring are less explored. We used four national registry and health insurance datasets in Taiwan from 2004 to 2009 to form a population-based matched retrospective cohort study. A total of 1056 neonates born to women in the MMT program (857 born before mother's enrollment in the MMT program [BM], 199 born after mother's enrollment in the MMT program [AM]) was established; 10547 matched non-drug [ND] exposed neonates were identified for comparison. Outcome variables included offspring's health insurance coverage and utilization of preventive, outpatient, and emergency room cares in the first year after birth. Infants born to mothers on MMT were more likely to have no or incomplete insurance coverage (BM: adjusted odds ratio [aOR]=1.29, 95% CI: 1.10-1.53; AM: aOR=1.56, 95% CI: 1.14-2.13) as compared with the socioeconomic status-matched ND group. The BM infants appeared to have fewer preventive care visits (adjusted relative risk [aRR]=0.85, 95% CI: 0.80-0.90), whereas the AM infants utilized outpatient and emergency room services more frequently (outpatient: aRR=1.11, 95% CI: 1.01-1.23; emergency: aRR=1.46, 95% CI: 1.11-1.90). Addiction treatment and harm reduction programs for women of childbearing ages should be delivered in the coordinated framework that ensures comprehensiveness and continuity in healthcare and social services. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Drug and alcohol dependence 06/2015; DOI:10.1016/j.drugalcdep.2015.05.044 · 3.28 Impact Factor
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    • "Some practitioners favour higher doses to limit illicit drug use and counteract the increased methadone clearance in pregnancy, which may necessitate a dose increase in the third trimester (Drozdick et al., 2002; Wolff et al., 2005). Others favour lower doses to try to reduce the incidence of neonatal abstinence syndrome (NAS) (Dashe et al., 2004) or using the lowest doses compatible with stability (Dryden et al., 2009). Splitting the daily dose in the third trimester can be a helpful strategy (III). "
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    ABSTRACT: The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
    Journal of Psychopharmacology 05/2012; 26(7):899-952. DOI:10.1177/0269881112444324 · 2.81 Impact Factor
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    • "Length of treatment and peak dose of NOS were correlated with multiple factors, including benzodiazepine use and infant birth weight. The influence of maternal benzodiazepine use on the course of NAS treatment has been noted elsewhere (Dryden et al., 2009; Berghella et al., 2003; Seligman et al., 2008) and the relationship to birth weight is expected, as medication dosing is based on infant weight, and higher doses require a lengthier wean. Maternal methadone dose, although not the focus of this paper, was also positively associated with receipt of treatment for NAS, length of treatment, and peak NOS dose. "
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    ABSTRACT: Neonatal abstinence syndrome (NAS) is a constellation of symptoms resulting from in utero exposure to opioids that appears in 30-80% of opioid exposed infants. Variability in NAS symtomatology is not well understood, and recently it has been suggested that the sex of the infant may play a role in predicting NAS severity. The current study examines the relationship of sex to need for NAS treatment, length of NAS treatment, and peak dose of medication required to treat NAS symptoms. Retrospective chart review of 308 infants was conducted to determine whether significant differences exist between male and female neonates in need for NAS treatment, length of treatment and peak dose of medication required. Chi-square, multiple ordinary least squares regression, and analysis of variance (ANOVA) analyses were conducted. No significant differences were found in need for NAS treatment, length of treatment or peak dose of medication required between male and female neonates. Results suggest that no significant differences exist in NAS severity between male and female infants.
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