Is methadone safe during pregnancy?
A pregnant woman who abuses opioid drugs may seriously damage both
herself and her unborn child. While methadone itself does not eliminate all potential
problems of pregnancy, participation in MMT greatly reduces the risks of illness
or even death in mother or child.
Methadone is one of only two approved and available medications in the U.S. for
treating opioid addiction during pregnancy (the second is buprenorphine). When properly
used as part of an MMT program, there has been no reported evidence of harmful effects
of methadone to the mother or unborn child.
A respected group of experts, gathered by the Institute of Medicine in 1995, concluded
that methadone maintenance, when combined with appropriate prenatal care, can reduce
the incidence of complications in the mother or fetus, the slowing of fetal growth
during pregnancy, and illness or death in the newborn infant. Withdrawal from methadone
treatment is rarely appropriate during pregnancy, as relapse to illicit drug use
is likely to occur. Although a mild form of opioid withdrawal syndrome may occur
in methadone-exposed infants, medical treatments are readily available to assist
in appropriate care of the newborn child.
Methadone maintenance is considered so vital for the health of pregnant opioid-addicted
women that Federal Regulations governing MMT programs require that these women are
given a preference for admission and that arrangements are made for proper medical
care during pregnancy. Years of experience have shown that there is no lasting harm
to the child from exposure to methadone during pregnancy. And it is important to
note that a baby born to a mother in MMT is always much better off both physically
and mentally than if the woman had continued using heroin or other street drugs.
Pregnant patients in MMT can and do deliver healthy babies. Also, by no longer injecting
drugs, these women avoid hazardous infections that could be transmitted to their
infants. Moreover, participation in MMT allows the mothers to receive proper perinatal
care, nutritional supplements, and parenting instructions.
It is true that the newborns sometimes experience withdrawal symptoms during the
first several days after birth. However, the symptoms are routinely treated by pediatricians
and do not result in any long-term damage. The neonates of women in MMT tend to
have lower birth weights compared with those of drug-free women, but they do not
exhibit any noteworthy developmental or neurological difficulties. Of importance,
compared with babies born to mothers on heroin, MMT has demonstrated great benefits
to both mothers and their infants.
Research has demonstrated that adequate methadone during pregnancy – at whatever
dose that is most effective for the mother – is not harmful to the fetus in terms
of the incidence and severity of postnatal withdrawal syndrome. Past research has
indicated that dose increases may be required during later stages of pregnancy to
maintain stability on methadone, and some clinicians recommend split doses for this
purpose. At the same time, however, some of the older literature recommends that
the dose during pregnancy should not exceed 20 mg/day and this potentially harmful
myth still persists among some practitioners.
Sources:
Berghella V, Lim PJ, Hill MK, et al. Maternal methadone dose and neonatal withdrawal.
Am J Obstet Gynecol. 2003;189:312-317.
Federal Regulation of Methadone Treatment. National Institute of Medicine. 1995.
Available online at:
http://www.nap.edu/books/0309052408/html/
Joseph H, et al. Methadone Maintenance Treatment (MMT): A Review of Historical and
Clinical Issues.
Mt Sinai J Med. 2000;67(5-6):347-364.
Available at: http://www.mssm.edu/msjournal/67/page347_364.pdf