ASSESSING THE RELATIONSHIP BETWEEN MATERNAL OPIATE USE AND NEONATAL-MORTALITY

Aims/Design. We undertook a number of meta-analyses to estimate more p recisely the relationship between neonatal mortality and use of opiate s in three groups of women. First, women who continued to use illicit heroin throughout pregnancy; secondly, women stabilized on methadone a t the time of conception or shortly after and thirdly, women who use h eroin well into pregnancy with late entry into methadone treatment, or who continued to use illicit heroin during pregnancy while receiving methadone. Findings. The pooled estimates of the relative risks of neo natal mortality for separate heroin and methadone use were both near u nity: 1.47 (95% CI 0.88-2.33) and 1.75 (95% CIT 0.60-4.59), respective ly. The result for heroin may be due to the inclusion in the meta-anal ysis of a particularly large study, which, unlike the two other smalle r studies included, found a relative risk near unity. When this study was excluded from the meta-analysis the pooled estimate of the relativ e risk of neonatal mortality for heroin use was 3.27 (95% CI 0.95-9.60 ). In contrast to the results for use of methadone only, the pooled re lative risk associated with heroin and methadone use was 6.37 (95% CI 2.57-14.68). Conclusions. The increased relative risk for neonatal mor tality associated with women using heroin and methadone during pregnan cy, compared to those stabilized an methadone, is probably due to the chaotic and high-risk life-style associated with illicit heroin use an d not solely to the use of heroin and methadone per se. It is recommen ded that women who use heroin well into pregnancy with late entry into methadone treatment, or who continue to use illicit heroin during pre gnancy while receiving methadone, receive special attention over and a bove that provided to women stabilized on methadone.