title: The effect of methadone dose regimen on neonatal abstinence syndrome.
abstract: OBJECTIVE
  To evaluate the effects of a multiple daily dose methadone regimen in pregnancy on neonatal outcomes.
  
  
  METHODS
  Although methadone maintenance has been the standard for the treatment of opioid dependence in pregnancy, there is no consensus on proper dosing. Single daily dosing is the most common strategy. Because of accelerated metabolism of methadone in pregnancy, this regimen may expose mother and fetus to daily episodes of withdrawal and possibly contribute to more severe Neonatal Abstinence Syndrome (NAS). This study reports on a protocol that increased both methadone dose and dose frequency in response to maternal reports of withdrawal.
  
  
  RESULTS
  Treatment of NAS was needed in 29% of neonates, compared to a published rate of 60% to 80%. The mean methadone dose was 152 mg at delivery, divided into 2 to 6 doses per day. Ninety-two percent of mothers were free of illicit drug use at delivery. There was no relationship between methadone dose and treatment of NAS. Female babies had a treatment rate of 16% versus 38% for male babies. Beyond abstinence symptoms, cohort outcomes in terms of gestational age, birth weight, prematurity, Caesarian sections, and breastfeeding equaled or approximated US population norms.
  
  
  CONCLUSIONS
  The protocol was associated with low rates of treatment of NAS and high rates of maternal recovery. High rates of treatment for NAS reported in methadone-exposed neonates might relate in part to iatrogenic factors and be reduced through the use of divided daily doses and protocols that minimize maternal withdrawal.
authors.affiliation: From the Bi-Valley Medical Clinic, Carmichael, CA (JJM); and Departments of Psychiatry and Behavioral Sciences (JJM, MHL, RS) and Statistics (NHW), University of California, Davis.
authors.forename: John J
authors.initials: JJ
authors.lastname: McCarthy
authors.forename: Martin H
authors.initials: MH
authors.lastname: Leamon
authors.forename: Neil H
authors.initials: NH
authors.lastname: Willits
authors.forename: Ruth
authors.initials: R
authors.lastname: Salo
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology*; D058850:Opiate Substitution Treatment / Q000009:adverse effects / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D008691:Methadone