Pharmacotherapy for pregnant women with addictions.
OBJECTIVE
Dependence on alcohol, nicotine, or illicit drugs during pregnancy continues to be a problem of major medical, social, and fetal consequences. The purpose of this systematic review was to summarize current experience that pertains to pharmacotherapy for pregnant women with specific chemical addictions.


METHODS
Studies were identified through Medline and HealthSTAR (1979-2003) that linked specific pharmacotherapy with pregnancy. This article reviews the English language literature for clinical studies that link the 2 conditions. In addition, reference lists of all articles that were obtained were evaluated for other potential citations.


RESULTS
Pregnant women are excluded systematically from almost all drug trials. Most knowledge about the fetal effects from maternal substance and medication use comes from animal data and from case reports and small clinical series. With the exception of methadone and nicotine replacement, clinical experience with antiaddictive medications in pregnant women is either very limited (alcohol, stimulants) or nonexistent (cannabis, hallucinogens).


CONCLUSIONS
Antiaddiction medications are important in the treatment of pregnant women with opioid and nicotine dependence and are of growing importance in the treatment of alcohol and stimulant dependence. Future directions will be toward increasing knowledge about current drug therapy and in developing new antiaddiction medications.
Rayburn
William F
WF
Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5580, Albuquerque, NM 87131-0001, USA. wrayburn@salud.unm.edu
Bogenschutz
Michael P
MP
D000293:Adolescent; D000328:Adult; D016739:Behavior, Addictive; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000188:drug therapy*
D009292:Narcotic Antagonists; D004364:Pharmaceutical Preparations; D008691:Methadone