April 23rd, 2019

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Title:
Pregnancy Outcomes of Women Supervised Under Professional Methadone Programs
Authors:  Conisha Holloman, M.D., Neeraj Desai, M.D., Stephen J. Carlan, M.D., and Tope Oshodi, M.D.
  OBJECTIVE: Methadone is approved for opioid addiction treatment in pregnancy and may improve obstetric outcomes as compared to the outcomes of those using illicit drugs or unsupervised methadone.

STUDY DESIGN: This is a retrospective cohort study of all deliveries from January 1, 2010, to September 1, 2013, at Winnie Palmer Hospital (n=34,483). Methadone data were obtained from the hospital pharmacy and the electronic labor and delivery log. Group 1 (n=55) included patients in supervised methadone programs. Group 2 (n=19) used illicit drugs. Group 3 (n=34,408) reported no drug use.

RESULTS: The primary outcome was preterm birth (PTB). Results showed a PTB rate of 14.5% in Group 1 and 52.6% vs. 12.3% in Groups 2 and 3, respectively (p<0.05). Women in professionally supervised methadone programs were noted to have improved outcomes as compared to untreated illicit drug users and comparable results to drug naïve women in regards to PTB, mean estimated gestational age (38.6±2.2 vs. 36.3±3.1 vs. 38.2±2.4 weeks, respectively), birth weight (3,037± 583 g vs. 2,747±667 g vs. 3,211±633 g, respectively), and NICU admissions (1.8%, 5.3%, and 8.6%, respectively).

CONCLUSION: There is underestimation of substance abuse in pregnancy and need for unbiased diagnosis and treatment. Providers should support resources that enable more women to enter supervised treatment programs.
Keywords:  amphetamine-related disorders, amphetamines, female, heroin/adverse effects, heroin dependence/complications, illicit drug use, methadone, narcotics, narcotics/adverse effects, opioid-related disorders, postnatal care, pregnancy, pregnancy complications, prenatal care, prescription drugs/adverse effects, street drugs/adverse effects, substance abuse, substance abuse detection
   
   
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