title: Obstetrical and neonatal outcomes of methadone-maintained pregnant women: a canadian multisite cohort study.
abstract: OBJECTIVE
  To describe obstetrical and neonatal outcomes including neonatal abstinence syndrome (NAS) in a Canadian cohort of methadone-maintained pregnant women.
  
  
  METHODS
  We conducted a retrospective chart review at three integrated care programs in Vancouver, Toronto, and Montreal. Pregnant women on methadone maintenance treatment (MMT) who attended for care between 1997 and 2009 were included in this multisite study. Maternal and neonatal outcomes in each of the three contributing centres were compared.
  
  
  RESULTS
  A total of 94 pregnant methadone-maintained women were included in the final analysis: 36 from Toronto, 36 from Vancouver, and 22 from Montreal. Maternal demographics showed inter-site differences in ethnicity and marital status. Obstetrical complications were not frequent; the most frequent was antenatal hemorrhage, which occurred in 14% of the total cohort. The incidence of premature labour was significantly higher in Vancouver and Montreal than in Toronto. The mean gestational age at delivery for the entire cohort was 38 weeks; mean birth weight was 2856 grams. The average length of hospital stay for babies with NAS was 19 days, with 27% of neonates requiring pharmacological treatment for NAS. Approximately 60% of neonates were discharged from hospital to the care of their mother.
  
  
  CONCLUSIONS
  Integrated care programs resulted in satisfactory obstetrical and neonatal outcomes for pregnant women on MMT. Policies promoting maternal-newborn contact, rooming-in, and breastfeeding may help to decrease the severity of NAS and the need for pharmacological treatment of NAS. We strongly recommend the development of similar programs across Canada to address gaps in services.
authors.affiliation: Toronto Centre for Substance Use in Pregnancy, St. Joseph's Health Centre, Toronto ON; Department of Family and Community Medicine, University of Toronto, Toronto ON.
authors.forename: Alice
authors.initials: A
authors.lastname: Ordean
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto ON; Substance Use Service, Women's College Hospital, Toronto ON.
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital, Toronto ON.
authors.forename: Lisa
authors.initials: L
authors.lastname: Graves
authors.affiliation: Perinatal Addictions, BC Women's Hospital, Vancouver BC; Sheway Clinic, Vancouver BC; Department of Family Practice, University of British Columbia, Vancouver BC.
authors.forename: Ron
authors.initials: R
authors.lastname: Abrahams
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto ON.
authors.forename: Theresa
authors.initials: T
authors.lastname: Kim
mesh_terms: D000328:Adult; D001724:Birth Weight; D001942:Breast Feeding; D002170:Canada; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D017533:Marital Status; D008691:Methadone / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D008691:Methadone
keywords: methadone; neonatal abstinence syndrome; pregnancy complications; prenatal care