Methadone and pregnancy: stop treatment or not?
Since 1998, the National Institutes of Health has recommended methadone maintenance as the standard of care for the opioid-dependent pregnant woman. We now have forty years of studies of opioid-dependent pregnant women show that both baby and mother do best if the mother is started and kept on methadone.
Many pregnant women, addicted to opioids, are told by well-meaning friends and family to do a dangerous thing during pregnancy. They are told to stop taking opioids while pregnant. Even pregnant patients on methadone through a treatment center are told by family to, Get off that stuff, not realizing stopping methadone during pregnancy can cause harm.
Opioid withdrawal usually won’t kill a healthy adult, though it can make him very sick. But opioid withdrawal can cause serious harm to the developing fetus, up to and including death, from miscarriage or pre-term labor. Maternal withdrawal from opioids causes increased fetal movement and increased oxygen consumption, potentially causing oxygen deprivation. Opioid withdrawal during pregnancy is associated with low birth weight and increased medical complications for both mother and child.
Pregnancy and methadone : The benefits of methadone treatment
Besides preventing withdrawal, methadone treats the mom’s opioid addiction. About 70% of pregnant opioid addicts will relapse back to illicit opioid use (heroin or pain pills not prescribed to them) if they are taken off methadone. We also know that women enrolled in a methadone treatment program are much more likely to get prenatal care, and babies born to moms on methadone have higher birth weights than mothers in active addiction. If the mother is dosed with methadone, the baby is much less likely to be exposed to infectious agents like HIV and hepatitis from shared needle use. The baby also won’t be exposed to adulterants that can cause fetal damage, if heroin is being used.
Therefore, the standard of care for opioid-addicted pregnant women is stabilization with methadone throughout the pregnancy, until delivery. And now, since the results of a new study have just been released, we can also recommend buprenorphine as an appropriate medication to stabilize the mother.
Consequences of baby born addicted to drugs – withdrawal
Certainly, the worst thing that can happen with a pregnant woman on methadone is the occurrence of neonatal abstinence syndrome (NAS). This is the term for opioid withdrawal symptoms seen in a newborn. Any opioid taken regularly during pregnancy can cause NAS. The new infant can have gastrointestinal symptoms and neurologic symptoms that need treatment with gradually reduced doses of opioid, usually a tincture of morphine solution. This can occur as quickly as within twenty-four hours, if the mother is using a short-acting opioid like heroin, or up to five days later, when the mother is taking methadone.
As bad as NAS is, it can be treated. No one wants to see an infant have withdrawal, but it’s still better than the alternatives: very premature infants needing months on intensive care, fetal loss, or low birth weight babies. Even in the face of the possible complication of NAS, the baby is likely to be healthier, as is the mother.
Methadone vs Subutex: Is Subutex better during pregnancy?
Now, we have a new option to methadone. A very recent trial, the MOTHER (Maternal Opioid Treatment: Human Experimental Research) trial, (1) compared opioid-addicted pregnant women who were put on methadone with pregnant women put on buprenorphine (better known by many as Subutex). There was roughly the same incidence of neonatal abstinence syndrome in both groups, but infants born to moms on buprenorphine had significantly milder withdrawal symptoms and required fewer days in the hospital. The bottom line is that both medications work well, but buprenorphine was better for the infants.