Methadone maintenance program in a Swiss perinatal center: (I): Management and outcome of 89 pregnancies.
BACKGROUND
Although methadone maintenance is the standard treatment of opiate addiction in pregnancy, opinion as to its utility is divided. The aim of this study was to analyze polydrug abuse, pregnancy outcome and fetomaternal complications among pregnant women in a major Swiss methadone maintenance program.


METHODS
Prospective data collection of all pregnant opiate addicts and their neonates from 1996 to 2001.


RESULTS
Maternal complications occurred in 73% and fetal complications in 34% of the pregnancies. The average methadone dose at delivery in the 89 pregnancies was 40.9 +/- 32.7 (0-150) mg/day. Sixty-four percent of the women were co-users of cocaine and/or heroin. Birthweight was lower in polydrug abusers than in near-exclusive methadone users (p = 0.001).


CONCLUSIONS
The high rate of maternal complications demonstrates the need for further improvement in antenatal management of opiate addiction in pregnancy. Methadone maintenance is inefficient in preventing pregnancy exposure to additional illicit drug consumption. Additional illicit heroin and/or cocaine abuse does not seem to increase the incidence of fetomaternal complications during pregnancy, but reverses the positive impact of methadone on birthweight. Heroin-assisted treatment may be a more effective method of minimizing the use of street drugs.
Kashiwagi
Maki
M
Department of Obstetrics and Gynecology, Zurich University Hospital, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland. maki.kashiwagi@usz.ch
Arlettaz
Romaine
R
Lauper
Urs
U
Zimmermann
Roland
R
Hebisch
Gundula
G
D000328:Adult; D001724:Birth Weight; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005313:Fetal Death; D047109:Fetal Development / Q000502:physiology; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016014:Linear Models; D008427:Maternal Health Services; D008691:Methadone / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013557:Switzerland; D016896:Treatment Outcome
D008691:Methadone