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Maternal Methadone Use And The Consequences On Baby

Maternal Methadone Use And The Consequences On Baby.

This report/study does have some great information….however I found it’s title more than a little angering.

450 women on methadone were studied.  At the end of the study they concluded that methadone treatment may cause an increased risk for prematurity and complications at birth….they also concluded that womens methadone dose during pregnancy had a direct correlation with NAS in the babies.

HOWEVER….what they don’t tell you is that 90% of these women SMOKED during their pregnancies and that most of them were very poor.  TWO FACTORS WE KNOW INCREASE THE RISK OF PREMATURITY IN INFANTS AND COMPLICATIONS AT BIRTH!

They also concluded that women should be kept on the “lowest methadone dose possible” while on methadone because the higher the dose the more chance of there  being medical intervention for NAS in the babies.

HOWEVER….they go on to say that a high percentage of the babies that needed treatment for NAS had mothers who continued to use ILLICITLY while on methadone treatment….which  says to me they weren’t on a HIGH ENOUGH dose.  Not to mention if other drugs are involved how can we accurately say that it was the methadone dose that correlated with NAS, and not the other drugs the moms where taking?  Perhaps this information actually tells us the opposite of the conclusion the authors came to…that adequate dose is essential because mothers who continue to abuse illicit drugs have an increased risk of NAS babies.

The one powerful thing I took away from this study was that moms on methadone should be encouraged to breastfeed because it reduces the chances of NAS in the babies.  Which tells me that giving moms the methadone dose they need (so that they do not use other drugs while pregnant) is still important because there is a way to increase the chances of the baby avoiding NAS after birth regardless of the circumstances during pregnancy.

I will write to one of our advocates who is a NP running a program for moms on methadone during pregnancy and hopefully we can get her to comment for us!

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  1. March 26, 2011 at 11:09 am

    Please please PLEASE go to:

    http://www.atwatchdog.lefora.com and post your story! There will be help!

    Contact us at ARMme.org and maybe we can get you some help close to home!

  2. anonymous
    February 25, 2011 at 6:13 am

    Thank u to every woman for comments and stories. Im 28 yrs old pregnant for the 3rd time however w/no children. I am an heroin addict however my 1st pregnancy I wasnt using daily and was able to taper off w/ little side effects. But even tho i didnt use i am high risk due to the bicornia uterus i have (my uterus is split in two the lef side can only carry a fetus till 6mos n the rightside can carry fetus to full term) I keep getting pregnant on the left smaller side. Since i had to go to welfare to get medical coverage i didnt have a huge variety of doctors to choose from so i did the best i could n chose a doctor i thot i could trust and he said i wasnt high risk i was absolutely fine and at 7mos i went into labor and delivered a stillborn babygirl. It left me broken i blamed myself and went on a heroin binder ab=nd 2 yrs later i went to detox and treatment in patient and got pregnant. I did not use however at 5mos my placenta detached and after 2 blood transfusions an emergency cesarian and almost dieing my tiny babyboy came into the world only to live for a few precious moments but his lungs couldnt support life and he passed away. . . . .
    Here i am now almost 3yrs later 17wks pregnant and in active addiction. I have tapered down xtremely I DO NOT WANT TO CONTINUE USING but the research ive been doing has said cold turhey can make me miscarry, that methadone is a safe way howevever the mgs is controversial, IN my county there is no detox or treatment centers or clinics there is NO HELP for addicts, i just need help info if any1 reads this please leave a comment. I want nothing more than this baby im not a bad person i have made bad decisions but i believe i deserve help as much as any1 else does. Thank you for this website and for stories comments they give me hope! ! !

  3. March 4, 2010 at 3:58 pm

    Thank you for telling us your story!

    They are finding a correlation now not with how high a moms dose is, but in moms who take other prescribed/unprescribed medications-especially benzo’s and antidepressants, which have their own withdrawal syndrome- these added medications clearly influence how long and how severe the NAS will be.

    This means that it is not dose that determines how severe a babies NAS will be, but other factors can contribute!

  4. sugarr
    March 3, 2010 at 11:52 pm

    I have 3 children & all were born while I was on a high dose of methadone & ALL of them had no withdrawl symptoms what so ever, so that is a possibility.

  5. armme
    February 19, 2010 at 1:43 pm

    Thank you for telling us about your experience! We are grateful to hear any story that involves the birth of baby!
    \
    Unfortunately, we can’t base how things will go for EVERYONE, by the results one person had. First, because many women who taper in your position WOULD suffer withdrawal and would seek relief illicitly. Also, although you didn’t experience the need to increase your dose during pregnancy, science tells us this is very rare. I don’t believe that any clinic would advise a mother to double her dose, unless her symptoms warrented it.

    I am sorry that your neonat specialist is wrong–we don’t have any concrete proof ONE WAY OR THE OTHER when it comes to maternal methadone dose. Many studies show absolutely no correlation. I believe this is because every pregnancy is different, every mom metabolizes methadone differently and each baby reacts differently to withdrawal. There is just no way to accurately predict. But what we do know FOR SURE, is that most opiate addicted mothers would be unable to do what you did, not because they don’t want to, but because their bodies won’t allow them to and their babies would be at risk if they did.

    Thank you for your story!

  6. Jennifer
    February 19, 2010 at 2:49 am

    I cannot believe the first poster was placed on 450 mgs of methadone!!! I also find it very hard to believe that the baby was born with NO symptoms.

    I also had my child on methadone. When I found out I was pregnant, I was on 80 mgs. Over the course of my pregnancy, I tapered SLOWLY down to 20 mgs. That was less than 10 mgs a month, and I didn’t have any withdrawals whatsoever. I monitered my son’s heartrate with a fetal heart monitor, and it never fluctuated. This means he wasn’t “withdrawing” as the clinics tell you will happen. I don’t think a fast taper is a good idea, but you certainly CAN do it. He was born at 8 lbs, 3 oz and the only withdrawal symptom he had was diarrhea for the first day. He was kept two more days for observation, just to be sure he didn’t go into any more withdrawals. He never needed to be placed on any medication whatsoever.

    I spoke to his neonatologist, and told him what the methadone clinics advise pregnant women to do, which is double their dose by the end of the pregnancy. He was SHOCKED. He said that he has seen a DIRECT CORRELATION between the level of dose the mother is prescribed and the baby’s NAS. He was so angry he called the methadone clinic to speak with them about their misinformation, and GUESS WHAT? They wouldn’t talk to him. What a shocker.

  7. December 21, 2009 at 8:47 pm

    Tara please go to:
    methadonesupport.org

    There you will find a whole forum of information on pregnancy while on methadone….as well as moderators who really know thier stuff about this treatment while pregnant!

  8. tara
    December 14, 2009 at 8:52 pm

    i have been in pain management for severe back problems for 5 years. in february i unexpectedly became pregnant. at the time i was taking 150 mg/day of oxycodone,4-5 somas a day, 240 mg. of ms contin, cymbalta fo0r depression and 1 mg of xanax. my doctors refused to let me wean, as they said it would most likely cause a miscarriage. everything went smoothly until my ultrasound at 24 weeks, when we looked at the scrreen and saw no heartbeat. my husband and i were devastated, still are. i had to go delivery my baby boy, who weighed just over 1 lb. this was in june, its now december, and i desperately desperately want to get pregnant. i recently switched to methadone only, about 60 mg. a day, and am hoping to taper off that quickly so i can get pregnant. i will never know if my pain meds caused my baby to die, the doctors had no explanation. i do not smoke, drink, ive never used any illicit drugs, my husband is an attorney and i stay at home with my 3 little ones. id like to hear from anyone who has been pregnant on methadone, if its safe, or if i need to wait until im off. its soooo hard to get off of, and my pain is horrible with0ut it. thanks so much.

  9. November 4, 2009 at 9:56 pm

    It’s great to see a Mainer and someone on Suboxone here! Thank you for telling us your story, Angie!

  10. Angie
    November 3, 2009 at 2:32 am

    I was only on 2 mgs of subutex the whole time I was pregnant with my first baby girl. She is now 13 months, she walked at nine months, she is very smart, and was 7lbs 2 ounces when she was born. She has always been in the 90% of her weight since her 1st month doctors visit. I thought she was not going to have to go on medication but after scoring her for 4 days in Maine Med she ended up going on a sub-therapeutic dose of Phenobarbital and we went home on the 8th morning. I don’t think women should get there hopes up that if you do everything right your baby won’t have NAS. I don’t smoke, don’t drink and NEVER used anything else except the prescribed dose. My prescribing physician told me she wouldn’t need medication because I was on so little medicine. It was hell watching her go through withdrawal and people telling me different things. Some nurses said she didn’t need meds and others were scoring her high and telling me she did. Neonatolgists came down 3 times and said they would continue “watching” her and go from there. Be prepared for nothing like any post delivery you have seen. Every three hours they come in and pick your up, wake the baby, put a cold thermometer on, hold the baby up three inches from the bassinet and drop it a little so see if the baby is loose or stiff, check the baby for diaper rashes, sneezing, crying, amount of time it slept, hiccups. Your baby could have hiccups, sneeze, not sleep for more than 2 hours in a three hour period (when the *itches are bugging you during that time anyways) and have a diaper rash and they score high enough to call the NICU. Its ridiculous. Than they expect you to swaddle and calm the baby after they just woke her up. Some nurses are the GREAT NURSES who care, treat you like a human not a criminal but the “picture perfect” nurses are the bitches that hate you and think you don’t deserve a baby and the whole family notices. Once you get to the Barbara Bush wing this all changes, they are awesome up there, just awesome. I am sure the scoring system works good for babies that are clearly in withdrawal but for babies that are on the cusp of needing medication its not a “healing” or “therapeutic” system. They make you feel like you are being tested and have to lie about how many sneezes or something. Like I said they score the baby every three hours and if they get a score of 7 or more three times in a row or a 12 twice in a row they call the NICU. If a baby has a high pitched scream its a 2 or a 3, sneezing hiccupping coughing is 1 or 2, skin mottling which a lot of babies who are not in withdrawal have is 1 point, and if they sleep less than 3 hours its 1 point, less than 2 hours its 2 points, and less than an hour 3 points, so the points add up quick and you figure you automatically get 2 points because it takes 1/2 hour to breastfeed, change a diaper, and hold the baby for comfort and than 5-15 minutes for the nurse to score so you’ve already burned an hour out of your three before they come back to score again so there’s two points because they know if you fed the baby the baby hasn’t sleep 3 hours. Than if lactation has come in or family you want the baby to be awake.

    My point is that its complicated, its tough, there’s discrimination which is usually warranted but not always, it depends on the hospital and how well they are trained with NAS, and a lot of the symptoms are common in babies that aren’t going through withdrawal but when accumulated make sense that it is withdrawal. I was on one the lowest doses possible, I did everything right and my daughter still ended up on medication. It was hell but it was easier than some, and lowering the dose definitely can get you less time in the hospital.

    Phenobarbital-treats nervous system symptoms of NAS, and tincture of Opium treats gastro symptoms, a baby cannot go home on the tincture medicine, so its best if just the Phenobarbital is used.

    Just remember, that people who have not been through addiction or withdrawal have a hard time understanding why you couldn’t just “get off the meds.” As the bible says “This too shall pass,”

    and Jesus loves everyone, ,,,,,,,,,,,,,, EVERYONE.

  11. August 10, 2009 at 4:03 pm

    When I read Jenny’s comments I was inclined to look back over the research I’d been doing for the past year (or so) regarding increased dosage of methadone during pregnancy. Here’s one article citation (from Loretta Finnegan, who developed the Finnegan Scoring tool for NAS):

    “Studies have shown the variability of methadone pharmacokinetics in pregnant women in comparison to non-pregnant individuals. Plasma methadone levels during pregnancy show marked intra-patient and inter-patient variability and usually are somewhat lower than those prior to pregnancy. This decrease can be explained by an increased fluid space, a large tissue reservoir, and altered drug metabolism by the placenta and fetus. These data suggest that pregnant women may need increasing methadone doses during gestation and that lowering the dosage in an attempt to minimize neonatal abstinence would be medically inappropriate.” http://pain-topics.org/pdf/europad/HeroinAdd11-2.pdf

    I am not a physician or a clinician but just wanted to pass along something that might offer insight to your situation. I agree with Kristan that as a mom myself, I can certainly appreciate guilt but you are doing the best you can to care for yourself and that is commendable.

    Good luck to you!

  12. August 6, 2009 at 10:56 pm

    I am so very sorry for your loss. Truly heartbreaking.

    The only thing I can say in attempt to ease your guilt is that babies are given methadone frequently for pain syndromes, withdrawal and that we know that long term methadone does not hurt any of our organs-so it should not have caused your babies brain to “die”. The reality is that your baby would probably have had this birth defect with or without your methadone use. Also, had you tried to withdraw or reduce your dose during pregnancy the detox would have put the baby at far greater risk than your stable use of methadone. To be sure being on methadone is not the best way to have a child…..but try to remember that people get pregnant and have children (sometimes even on purpose) under a wide array of horrible circumstances, on much more toxic medications and with diseases that can hurt the mom and the child. Please try to heal this guilt, because it truly truly was not your fault.

    As a mom I know the agony of motherhood guilt. As someone who has miscarried I also know the guilt of feeling like you lost the baby because of something that you did. Sometimes there is no explanation, no matter how desperately we want one. But if I were you I would start by asking for my records and for the pathology reports of the birth. If there is a name for what your baby had, you will find it there.
    Kristan

  13. jenny
    August 5, 2009 at 5:55 am

    i was on went up to 140mg. of methadone during my first pregancy ( the clinic insists that yous dose increase through out the pregnancy , i didn’t agree yet they really didn’t give me much of a choice, i was very uneducated about the whole thing back then) my daughter had to stay in the hospital for 30 days yet did not show signs os withdrawl. My daughter is now 2 years old and is perfect in every way . Yet my 2nd pregancy a year later ( at this time only on 80mg.) ended when i was 5 months pregnant and i was told that my daughter had ” something wrong w/her brain.” they never gave me a real explaination as to what was wrong, best explained as , she was brain dead. as a result a was unable to keep this child who was very muched wanted, loved, been named, given god parents, had a family that loved her and a life that we had planned to spend with her. I feel there was no reason why this happened besides my use of methadone, i feel that my doctor just kept raising my dose of methadone even when i said that i had felt completly fine on the lower dose i was on, he said though i may not feel any signs of withdrawl my baby may and an increase was nessasary if i wanted to ensure the good health of my child. instead of being in my arms my daughter is now laying in cemetary, what date do you put on the headstone of a baby that died before she was born???
    i am still working on getting of methdone ,now on 30mg. and if i were to ever get pregant again while on methadone ( i am waiting until I am completely off all medication before i even think of having another baby) i would get off methdone in as soon as possible yet i would not just stop i would lower my dose in a ” safe ” manner, basically, even with one healthy child i still lost my second child and i will never know if methadone truley played a part in her life being over before it started but i would never take the chance again.I wish i hadn’t listen to the doctors and listened to myself and my body if this would have happened to my daughter while a was not on methadone it would still hurt just the same yet i wouldn’t have to live with the guilt of wondering if this was my fault.

  14. July 16, 2009 at 4:08 pm

    Michelle-please go to http://www.methadonesupport.org and go to the MOMS section…which is run by a Nurse Practioner who runs a special program for methadone maintained moms and their newborns. I am sure they will be very helpful!

  15. Michelle
    July 14, 2009 at 9:09 pm

    also if anybody has any other websites i could do fither research for effects on methodone babies and development please emiail me.

    Thank you,

    Michelle

  16. Michelle
    July 14, 2009 at 9:03 pm

    Tahanks for all your support. does anybody know if a methodone baby will be slow in learning or growing?????
    im currently in a treatment center and will be reunited with both of my children. my daughter is 5yrs old born drug free. my sison is my concern he detoxed after delivery i was on 140 mg and will be reunited soon…. i am now clean from all opiates and not taking metghodone no more.

  17. July 14, 2009 at 3:17 pm

    Thank you Amanda!

    So many studies have included women who smoke, are very poor, have little prenatal care and/or are abusing other drugs, so it’s hard to come to solid conclusions.

    This we do know:
    -your baby is much more at risk if your using street drugs while pregnant
    -methadone reduces the use of street drugs in pregnant women
    -smoking, poor nutrition (usually due to poverty) and poor pre-natal care all have short and long term side effects to unborn children

    The Director for one of Maines methadone clinics just recently did a documentary on some of her pregnant women in treatment. All had good outcomes.

    I have yet to meet a woman who took ONLY methadone during her pregnancy, who has a child that suffered long term effects. I know women on methadone who just had their babies and women who have children in their twenties.

    Just remember that women have babies under all sorts of circumstances, despite huge risk and while on many different types of medication every single day in this country. No one questions the mothers devotion to her child when they give birth despite being diabetic, for instance, even though it’s very risky for the mom and the child. But women on methadone are dismissed and stigmatized for their desire to continue their medication while pregnant. Despite decades of research that tells us it’s the proper course of action for methadone dependent pregnant women.

    You did what you had to do to keep both yourself and your child healthy until birth. Even if your baby suffered withdrawal symptoms, always remember that it is not even close to the worst thing that newborns suffer through in order to make it into this world alive and well!

    Remember too, that once you were pregnant you had NO CHOICE but to continue to take your methadone….or you truly would be risking miscarriage or still birth. Staying on methadone was a choice made out of love, not selfishness.

  18. July 14, 2009 at 12:50 pm

    I suggest checking out the article (http://suboxforum.com/addman.pdf) by Gary Helmbrecht and Siva Thiagarajah (Journal of Addiction Medicine). It has a lot of info about the effects of methadone and buprenorphine on babies.

    Here is a quote from the article:
    “The results of these and other studies suggest that even after treatment for the neonatal abstinence syndrome, infants of drug-dependent mothers seem to differ from comparison children, which could indicate later developmental problems. It is difficult, however, to establish what effects are directly attributable to methadone, because many methadone patients in these studies used other drugs and had socioeconomic characteristics that are associated with poor neonatal outcome… regression analyses demonstrated that amount of prenatal care, prenatal risk score, and home environment were most predictive of intellectual performance and that the degree of maternal narcotic use was not a significant factor. These findings suggest that in the cognitive domain, methadone may not cause a behavioral deficit but instead create vulnerability in these children that then makes them more susceptible to impoverished environments.” (p. 10)

    And another:
    “…opiates are not associated with fetal malformations and the observed adverse pregnancy outcomes are secondary to withdrawal and parallel high-risk behaviors. We now have more than 3 decades of experience with the use of methadone for opiate detoxification and agonist treatment. Long-term abstinence after detoxification is unusual in opiate addiction, and the best results have been demonstrated with continued use of opiate agonist therapy.” (p. 9)

    Hope this helps!

  19. July 14, 2009 at 12:30 pm

    Studies have shown that mothers who utilize methadone treatment while pregnant (without using other drugs) have children who are just as smart and capable as children born to non-addicts.

  20. Michelle
    July 13, 2009 at 9:08 pm

    hi my son was a methodone baby he came off of it with phetabarbital with no problem he is now 2yrs old i wonder if ther will be any side effects or learning disability.

  21. April 8, 2009 at 7:57 pm

    Please keep us updated, Amanda.

    We always look forward to your newsletter to let us know what is going on in Maine (as well as the website!).

  22. April 3, 2009 at 12:31 pm

    Thank you for posting this article and to Jennifer K. for sharing her story! The Portland Women’s Task Force (Portland Public Health Division community partnership) is working on a Springtime campaign for pregnant women and the community regarding the myths/facts about methadone use during pregnancy. We’ll keep you posted and again, thank you, Jennifer!!!!

  23. April 3, 2009 at 11:47 am

    Thank you Jennifer….it is wonderful to hear from someone who has actually been through this.

  24. April 2, 2009 at 10:30 pm

    Hi. I started Methadone when I was pregnant with my daughter. I was on 450mg a day before the end of my pregnancy and my daughter was born perfectly healthy! When they tested her at birth for Methadone, she was actually NEGATIVE. She had NO NAS and I only wish that back then (2003) that they had let me breastfeed. Back then they said it was dangerous, so I didn’t do this. When I talked to my daughter’s neonatologist (they put her in NICU because I was on Methadone.) he said that the reason she was born NEGATIVE for any traces of Methadone is because I was on the RIGHT dose. Another lady on MMT came into labor and delivery while I was there. She was on 45mg a day and her child was in NICU for TWELVE weeks recovering from NAS, but she also continued to use heroin and crack all throughout her pregnancy. So there is something to say for those of us that use our meds CORRECTLY!! The docs need to look at the WHOLE picture and not just the fact that we are on Methadone. They need to see if we are still using and what other factors contribute to NAS. Thanks.

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