[Withdrawal syndromes of newborns of pregnant drug abusers maintained under methadone or high-dose buprenorphine: 246 cases].
Perinatal prognosis of pregnant drug abusers is better with intensive prenatal care and substitution maintenance programs. There is a large body of data in the literature on methadone (MTD), but very little on high-dose buprenorphine (HDB). The objective of this study was to compare 2 groups of pregnant women maintained on MTD or HDB for perinatal events.


METHODS
Prospective multicentric study; all neonates (NN) whose mothers has been maintained during pregnancy on MTD or HDB were included by 34 French perinatal centers with specialized staff for care of these pregnant drug abusers.


RESULTS
Two hundred and forty-six pregnant women were included: 93 (38%) MTD and 153 (62%) HDB. Social and perinatal data, prenatal care and factors correlated with poor prenatal care are reported. Forty-six percent of the pregnant women had good prenatal care; 88% had peridural analgesia; mean birthweight=2838g; mean gestational age=38.7 weeks; prematurity<37 weeks=13; intra-uterine growth retardation=32%. Sixty-five percent neonates had withdrawal neonatal syndrome (WNNS) at a mean age of beginning at H40, mean highest Lipsitz score was 8.2 at H78. Half of the neonates with WNNS received treatment, mainly with morphine chlorhydrate. Neonatal mortality was 0/246. Discharge of the neonates was 60% with their father and their mother, and 32% with their mother alone; 4% were placed in foster homes by judicial decision. The only statistically significant differences between the MTD and HDB groups were: maintenance program was more frequently initiated before this pregnancy for the HDB vs MTD group (p<0.03); MTD maintenance was more often supervised by maintenance specialized centers and HDB by general practitioners (p<0.001); prematurity was 18% for MTD group vs 9% for HDB group (p<0.04); mean age of maximum Lipsitz score was H92 for MTD group vs H70 for HDB group (p<0.001).


CONCLUSIONS
The perinatal medical and social prognosis of these 246 pregnant drug abusers and of their neonates appeared to be improved by the specialized prenatal care, comparatively with literature data. Perinatal impact of substitution program during pregnancy would be similar with MTD or HDB.
Lejeune
C
C
Groupe d'Etudes Grossesse et Addictions , Service de Néonatologie, Hôpital Louis-Mourier, 92701 Colombes. claude.lejeune@lmr.ap-hop-paris.fr
Aubisson
S
S
Simmat-Durand
L
L
Cneude
F
F
Piquet
M
M
Gourarier
L
L
D000701:Analgesics, Opioid / Q000009:adverse effects*; D002047:Buprenorphine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects*; D009020:Morphine / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000534:rehabilitation*; D011295:Prenatal Care; D011379:Prognosis; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000534:rehabilitation*
D000701:Analgesics, Opioid; D002047:Buprenorphine; D009020:Morphine; D008691:Methadone