Retrospective Study of Substance Abuse During Pregnancy Concludes:
"Despite multidisciplinary coordinated antenatal care, women with substance abuse during pregnancy are at significant risk of adverse obstetrical and perinatal outcome ..." Two comments: among the "substance abuse" cohort 66% smoked compared to 2.4% of the controls. Secondly, in the facilities studied "women are always encouraged to reduce their overall drug use (prescribed and illicit) during the pregnancy ..." And indeed this policy - which runs counter to all the evidence on treating opiate dependence with methadone during pregnancy - resulted in an average daily dose at the time of delivery of 35 mg. When providing grossly suboptimal dosages of medication it is hardly surprising that patients (and in this case their offspring) have suboptimal outcomes. It's difficult to comprehend how this practice could be rationalized by the clinicians, and perhaps even more difficult to understand how the investigators could fail to mention this detail in their report. Study: Pinto et al; Eur J ObGyn and Reproductive Biol, 150 (2010) 137-141.
This blog was sent to the senior author of the paper who asked that the following reponse be added:
We note the rather unsubstantiated comment above. There are a wide range of management options for methadone maintenance during pregnancy and for the management of illicit drugs during pregnancy, as we assume the author of the blog entry is aware. These even include withdrawal therapy. The inference that higher doses of methadone plus allowing unrestricted and unadvised illicit use of any drug during pregnancy could lead to better outcomes needs no real rebuttal, as it is self evidently wrong. Most would regard such an approach as poor care.
In our population women are stabilised on methadone if necessary and incremental dosage reduction attempted where feasible. This is a well recognised practice. Removing the risks of illicit drug use is a priority in most services.'
Pinto Shanthi (RBT) Mid Cheshire Tr