Objective To assess the obstetric and neonatal outcomes of pregnant women enrolled on a methadone substitution programme.
Design Retrospective case-control study.
Setting Maternity unit of an inner city hospital and tertiary referral centre in London, UK.
Subjects Pregnant women whose methadone substitution programme was managed at St Thomas' Hospital and who delivered between January 2005 and March 2008. Each subject had two matched controls.
Methods Data were collected from maternal and neonatal records. Certain patient demographics were also analysed.
Results There were 44 pregnancies resulting in 46 live births. The methadone group had a higher incidence of smoking (86.4%) and alcohol consumption (34.1%) during their pregnancy and 43% booked after 20 weeks gestation. There were fewer caesarean sections and more vaginal deliveries in the methadone group (88.2% vs 69.3% in controls). Overall, neonates in the methadone group were born earlier, weighed less and had smaller head circumferences compared to controls (p<0.001). 12 babies suffered from NAS, eight of whom required treatment, with a median stay of 14 days in SCUs. The relationship between methadone dose and incidence of NAS was significant (p=0.039). The methadone group frequently had issues relating to their relationships and accommodation.
Conclusion Pregnancy in women on methadone substitution is complicated by prematurity, low birth weights and NAS. Generally the outcomes are less favourable than for women in the control group. Hence there is still a need to develop antenatal care in opiate addicted mothers to improve neonatal outcome. Associated relationship and accommodation problems should also be addressed.
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