Relationship between maternal methadone dosage and neonatal withdrawal.
OBJECTIVE
To determine whether maternal methadone dosage affects duration and degree of neonatal narcotic withdrawal.


METHODS
This was a retrospective cohort study of pregnant women with opioid addiction who delivered live-born singletons between April 1990 and April 2001. Inpatient detoxification or outpatient methadone maintenance therapy was offered. Women who had a positive drug screen or whose neonate tested positive for opioids were considered to be supplementing. We evaluated indices of neonatal withdrawal according to the maximum daily methadone dosage in the last week of pregnancy.


RESULTS
Seventy women with opioid addiction were followed. Median methadone dosage was 20 mg (range 0-150 mg), and 32 infants (46%) were treated for narcotic withdrawal. Among women who received less than 20 mg per day, 20-39 mg per day, and at least 40 mg per day of methadone, treatment for withdrawal occurred in 12%, 44%, and 90% of infants, respectively (P < 0.02). Methadone dosage was also correlated with both duration of neonatal hospitalization and neonatal abstinence score (r(s) =.70 and.73 respectively, both P <.001). Neonates were more likely to experience withdrawal if their mothers were supplementing with heroin, 68% versus 35% (P =.01). Regardless of supplementation, there was a significant relationship between methadone dosage and neonatal withdrawal (P <.05).


CONCLUSIONS
Maternal methadone dosage was associated with duration of neonatal hospitalization, neonatal abstinence score, and treatment for withdrawal. Heroin supplementation did not alter this dose-response relationship. In selected pregnancies, lowering the maternal methadone dosage was associated with both decreased incidence and severity of neonatal withdrawal.
Dashe
Jodi S
JS
Department of Obstetrics & Gynecology, The University of Texas Southwestern Medical Center, Dallas, USA. jodi.s.dashe@drexel.edu
Sheffield
Jeanne S
JS
Olscher
Debora A
DA
Todd
Sally J
SJ
Jackson
Gregory L
GL
Wendel
George D
GD
D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008691:Methadone / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis* / Q000628:therapy; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011247:Pregnancy; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors
D003932:Heroin; D008691:Methadone