Elsevier

Obstetrics & Gynecology

Volume 100, Issue 6, December 2002, Pages 1244-1249
Obstetrics & Gynecology

Original research
Relationship between maternal methadone dosage and neonatal withdrawal

https://doi.org/10.1016/S0029-7844(02)02387-6Get rights and content

Abstract

Objective

To determine whether maternal methadone dosage affects duration and degree of neonatal narcotic withdrawal.

Methods

This was a retrospective cohort study of pregnant women with opioid addiction who delivered live-born singletons between April 1990 and April 2001. Inpatient detoxification or outpatient methadone maintenance therapy was offered. Women who had a positive drug screen or whose neonate tested positive for opioids were considered to be supplementing. We evaluated indices of neonatal withdrawal according to the maximum daily methadone dosage in the last week of pregnancy.

Results

Seventy women with opioid addiction were followed. Median methadone dosage was 20 mg (range 0–150 mg), and 32 infants (46%) were treated for narcotic withdrawal. Among women who received less than 20 mg per day, 20–39 mg per day, and at least 40 mg per day of methadone, treatment for withdrawal occurred in 12%, 44%, and 90% of infants, respectively (P < 0.02). Methadone dosage was also correlated with both duration of neonatal hospitalization and neonatal abstinence score (rs = .70 and .73 respectively, both P < .001). Neonates were more likely to experience withdrawal if their mothers were supplementing with heroin, 68% versus 35% (P = .01). Regardless of supplementation, there was a significant relationship between methadone dosage and neonatal withdrawal (P < .05).

Conclusion

Maternal methadone dosage was associated with duration of neonatal hospitalization, neonatal abstinence score, and treatment for withdrawal. Heroin supplementation did not alter this dose–response relationship. In selected pregnancies, lowering the maternal methadone dosage was associated with both decreased incidence and severity of neonatal withdrawal.

Section snippets

Materials and methods

We conducted a retrospective cohort study of pregnant women with opioid addiction who delivered live-born singletons of at least 25 weeks’ gestation between April 1, 1990 and April 30, 2001. Pregnancies were prospectively followed by the Parkland Hospital Perinatal Intervention Program, a multidisciplinary medical and social case management team of physicians, nurse practitioners, drug counselors, and social workers whose services are available to any pregnant woman in Dallas County with a

Results

Seventy pregnancies were followed by the Perinatal Intervention Program during the study period. Twenty-seven women (39%) underwent opioid detoxification, and 43 (61%) chose methadone maintenance. The median daily methadone dosage (maximum for the week prior to delivery) was 20 mg, ranging from none to 150 mg.

Maternal demographic characteristics are presented in Table 1, stratified by maximum methadone dosage in the week prior to delivery. Seventy-nine percent of the group tested was positive

Discussion

We found a significant correlation between the amount of methadone a pregnant woman receives shortly before delivery and her neonate’s likelihood of withdrawal. This topic has been controversial for more than a quarter century, with a number of investigators unable to demonstrate any dose–response relationship,3, 9, 10, 16, 17 and others reporting results similar to ours.13, 14, 15 A MEDLINE search from 1996 through 2001 for the terms “methadone” and “pregnancy” confirms that this is the

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