Methadone maintenance in pregnancy: A reappraisal
OBJECTIVE: The purpose of this study is to compare pregnancy outcome in women receiving inethadone maintenance to women using cocaine and drug free controls. STUDY DESIGN: Thirty-two pregnancies in women receiving methadone maintenance were matched hy gestational age to women with a positive urine screen for cocaine on admission to deliver) and drug free controls. Pregnancy outcome variables were compared including birth weight, and neonatal morbidity. Analysis was by X2 and "t" test with significance at 0.05. RESULTS: Birth weight for women on methadone was 2748 g vs. 2925 g for cocaine and 3032 g for controls, p = NS. Birth weight comparison of women using 50 nig of methadone to those using <50 mg was not different. Women using cocaine had a significantly higher incidence of meconium in lahor compared to methadone and controls. Of women on methadone 27/32 (84.3%) were positive for other drugs of abuse in the last screen prior to or at delivery, with cocaine 12/32 (37.5%), other opiates 13/32 (40.6%) and marijuana 14/32 (43.7%) being the most prevalent. Neonatal withdrawal occurred in 23/32 (72%) women on methadone. Neonatal withdrawal was as likely for women using <50 mg of methadone, 61.5% vs 79.0%, p = NS. Three neonates in the methadone group had major congenital anomalies with 2/3 (66,6%) resulting in mortality. CONCLUSIONS: Neonatal withdrawal is independent of maternal methadone dose. Women on methadone are likely to abuse other illicit drugs.
