METHADONE-MAINTENANCE IN PREGNANCY - A REAPPRAISAL

OBJECTIVE: The purpose of this study is to evaluate women receiving me thadone maintenance during pregnancy. STUDY DESIGN: Thirty-two pregnan cies in women receiving methadone maintenance were matched by gestatio nal age to women with a positive urine screen for cocaine at delivery and to drug-free controls. Pregnancy outcome variables were compared, including birth weight and neonatal morbidity. Analysis was by chi(2) and t test with significance set at .05. RESULTS: Birth weight of meth adone-exposed infants was 2748 g versus 2925 g for cocaine and 3032 g for controls, P = not significant. Birth weight comparison with a 50-m g maternal methadone cutoff dose was not different. A head circumferen ce for methadone infants of 32.4 +/- 4.7 cm was significantly less tha n controls, 33.5 +/- 4.0 cm, P <.04, but not different from infants of cocaine users, 32.8 +/- 3.1 cm. Women using cocaine had a significant ly higher incidence of meconium in labor compared with methadone and c ontrols. Of women taking methadone 27 of 32 (84.3%) were positive for other drugs of abuse in the last screen before or at delivery. Cocaine 12 of 32 (37.5%), other opiates 13 of 32 (40.6%), and marijuana 14 of 32 (43.7%) were the most prevalent. Neonatal withdrawal occurred in 2 3 of 32 (72%) women taking methadone. The neonates of women using <50 mg of methadone were as likely to withdraw as those women using greate r than or equal to 50 mg, 61.5% versus 79.0%, P not significant. Three neonates in the methadone group (9.3%) had major congenital anomalies , with 2 of the 3 (66.6%) resulting in mortality CONCLUSIONS: Birth ou tcome is not significantly different between methadone and cocaine use rs. Women receiving methadone maintenance are likely to abuse other il licit drugs.