Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources
Article first published online: 11 FEB 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 5, pages 665–671, April 2009
How to Cite
Dryden, C., Young, D., Hepburn, M. and Mactier, H. (2009), Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 665–671. doi: 10.1111/j.1471-0528.2008.02073.x
- Issue published online: 11 MAR 2009
- Article first published online: 11 FEB 2009
- Accepted 10 November 2008. Published Online 11 February 2009.
- health resources;
- neonatal abstinence syndrome
Objectives The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women.
Design Retrospective cohort study from 1 January 2004 to 31 December 2006.
Setting Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women.
Population Four hundred and fifty singleton pregnancies of drug-misusing women prescribed substitute methadone in pregnancy.
Methods Case note review.
Main outcome measures Development of NAS and duration of infant hospital stay.
Results 45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34–0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7–17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days.
Conclusions Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources.