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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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    • "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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    • "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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    • "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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