Taking Methadone During Pregnancy
The Reasons for and Problems with Perinatal Methadone Use
Aug 30, 2009
Also used for chronic pain management, methadone is a long-acting synthetic opioid drug. Heroin addicts who become pregnant have few choices that can safeguard their health. Even if they want to quit, the effects of heroin withdrawal can endanger the unborn.
Going Cold Turkey
Stopping opioid use abruptly causes withdrawal symptoms: runny nose, chills, vomiting, diarrhea, sweating, painful muscle aches and loss of appetite. During the first trimester, narcotic withdrawal can result in spontaneous abortion of pregnancy. The middle trimester is a "window of opportunity" when narcotic withdrawal is least harmful. In the last months of pregnancy, however, the risk of premature birth during heroin detoxification is highest.
Standard of Care
In 1998 The National Institute of Health recommended methadone maintenance for pregnancy. Not only is pregnancy loss prevented by methadone, but by ensuring a safe source of narcotics for the mother, the fetus is protected from acquiring blood-borne diseases through needle sharing, a common practice among addicts.
Methadone dosage must be titrated by a professional to avoid respiratory depression and death.
Methadone clinics administer one dose per day, so the mother must travel to the clinic site daily.
Methadone is a pregnancy risk category B drug, meaning that either animal studies have shown no risk but there are no controlled studies on pregnant women or, animal studies have shown adverse effects that were not confirmed in controlled studies in women in the first trimester and there is no evidence of harm in later trimesters of pregnancy.
Side Effects of Methadone in Pregnancy
Side effects of methadone for pregnant women include nausea, vomiting and severe constipation.
The unborn baby will show decreased viability on fetal monitor strips taken during the last trimester of pregnancy. Opiate antagonists, a classification of drugs commonly given for pain in labor, will cause a methadone-dependent mother to have symptoms of detox, making her more uncomfortable and endangering her newborn. Doctors and nurses must be made aware of any patients who are currently on methadone maintenance therapy at the time of birth. Mothers should understand this and be prepared to inform physicians who are covering for their regular obstetrician and nurses who are changing shifts, in case they have not taken time to read the chart or gotten adequate information from the relieved person.
Babies born addicted to methadone will experience withdrawal symptoms. An infant's withdrawal symptoms can be managed with barbiturate drugs. Although they are generally considered safe when used as prescribed, no one knows the effects of these medications on early bonding behavior.
Detoxing Methadone after Pregnancy Ends
Because of the drug's long half-life gradual weaning from methadone is easier than abrupt heroin withdrawal. Addicts need social support systems such as counseling and 12-step programs like Narcotics Anonymous to maintain motivation and stay clean.
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