EMCDDA Papers - Pregnancy and opiod use:strategies for treatment
Illicit opioid consumption is associated with a sixfold increase in obstetric complications in pregnant women. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neurobehavioural problems, increase in neonatal mortality and a 74-fold increase in sudden infant death syndrome. The primary goal of treatment for opioid dependence in pregnant women is to stabilise the patient, in order to avoid the permanent fluctuation of plasma levels and related foetal consequences, such as foetal distress and preterm birth. Psychosocially assisted opioid substitution treatment is the first-line treatment for opioid dependence in pregnant women, and several combinations of substitution medicines and psychosocial approaches are available. The pharmacological interventions studied in this overview were methadone, buprenorphine and slow-release oral morphine; the psychosocial interventions were cognitive behaviour approaches and contingency management. The observed differences between the three substitution approaches did not show a homogeneous and comprehensive pattern to conclude that one treatment is superior to the others for all relevant outcomes. While methadone seems superior in retaining patients in treatment, buprenorphine seems to yield to less severe neonatal abstinence syndrome and higher birth weight.