5261.0: Wednesday, November 15, 2000 - Board 3

Abstract #16256

Methadone treatment in pregnancy: Improving maternal and fetal outcomes

Thomas J McNanley, MD1, Theresa A Caffery, RNMS2, Gloria J Baciewicz, MD3, Kim M Hober, MSW2, and Mary Ellen Ross, RNC2. (1) Depatment of Obstetrics and Gynecology, University of Rochester, 601 Elmwood Box 668, Rochester, NY 14642, 716-275-7470, Thomas_McNanley@urmc.rochester.edu, (2) Department of Obsterics and Gynecology, University of Rochester, 601 Elmwood Box 668, Rochester, NY 14642, (3) Department of Psychiatry, University of Rochester, 300 Crittenden Blvd, Rochester, NY 14642

Objective:

To compare the perinatal outcomes of patients managed by two different methadone maintenance protocols: maximum dose limited versus "symptom-based dosing".

Methods:

A retrospective chart review of maternal and fetal outcomes. From 1989 to 1993, 12 pregnant women were enrolled in our methadone maintenance program. We limited the maximum dose of methadone to 30 mg/day. Four of these women became pregnant while in the program. Each was weaned to a lower dose. In 1993, we adopted a "symptom-based" dosing protocol, wherein the maximum dose was dictated by withdrawal symptoms. Since the change, we have enrolled 28 pregnant women. Continuous outcome variables were analyzed by Students' T test or Mann Whitney U, and nominal variables by Chi square or Fisher Exact Test.

Results:

With the symptom-based approach, higher average and total doses were received during the pregnancy. There were fewer positive urine screens for illicit drugs as well as shorter lengths of stays for the newborns. No difference was seen in other neonatal outcomes or birthweights. Patients treated by symptom based protocol were more compliant with prenatal visits, stayed in the program for longer periods of time, and were more likely to engage in further treatment.

Conclusion:

"Symptom-based" dosing of methadone improves compliance with treatment and prenatal care and is not associated with untoward neonatal effects. Despite this, concomitant illicit drug use remains a problem.

Learning Objectives: 1. Describe the impact of "symptom-based" dosing of methadone on perinatal outcomes. 2. Desribe how "symptom-based" dosing may impact on long term womens health

Keywords: Methadone Maintenance, Pregnancy

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA