Question 11: Is it necessary to reduce methadone dose or detoxify women from methadone during pregnancy to protect the fetus?
Answer: No. Women have been safely maintained on stable methadone dosage during pregnancy without adverse long-term effects on their health and the health of their infants. Withdrawal of medication during pregnancy leads to opioid abstinence syndrome, which is harmful to the pregnancy and often leads to relapse to illicit drug use. Dosage change in pregnancy must be carefully evaluated on an individual basis. Some women experience lowered blood levels of the methadone during pregnancy and may need an increase in dosage or split (e.g., twice daily) dosing. It is important to determine the relapse risk for each woman when considering a dosage change because a woman steadily maintained on methadone is more likely to have a healthy pregnancy and infant than a woman who uses alcohol and other drugs. The intermittent periods of withdrawal that typically occur with illicit opioid use and can adversely affect the fetus do not occur when methadone is individually determined and properly administered.
Research Highlights
- Optimal methadone dosage for pregnant women in methadone maintenance treatment should be based on careful consideration of risks and benefits to both mother and fetus on an individual basis. Individual dose should be evaluated, taking into account the stage of pregnancy, the relapse risk potential of the mother, pre-pregnancy methadone dose, previous experience with methadone, and history of addiction recovery. When the mother does not relapse to illicit drug use, short-term reductions in maternal dose have been effectively administered during the last stage of pregnancy. However, many women in treatment have been successfully maintained on a constant dose and, in some cases, on an increased dose to keep blood levels stable throughout pregnancy (Finnegan, 1991).
- Some women in treatment experience decreased blood levels of methadone during pregnancy, causing withdrawal symptoms. This decrease in blood levels of methadone during pregnancy can be accounted for by an increased fluid space, a large tissue reservoir that can store methadone, and drug metabolism by both the placenta and the fetus. Pregnant women in treatment with low blood levels of methadone frequently experience a high level of discomfort, withdrawal symptoms, and drug craving and anxiety and may be at high risk of relapse to opioid use and treatment dropout. Determination of methadone blood levels and possibly raising the methadone dosage to maintain sufficient blood levels may be warranted in such cases but must be carefully evaluated. Dosages should be evaluated in conjunction with ongoing medical monitoring of the pregnancy. Since the greatest risks to maternal and infant health occur when women in treatment relapse to illicit drug use, it is important to promote methadone dosage stability during and after pregnancy to optimize both maternal and child health (Kreek, Schecter, Gutjahr, et al., 1974; Pond, Kreek, Tong, et al., 1985).
Methadone Dosage Adjustment During Pregnancy – Figure 25 outlines the three main considerations regarding dosage for pregnant women in methadone maintenance treatment.
Figure 25 illustrates the safety of methadone maintenance treatment for pregnant women and their infants.
References
Finnegan L. Treatment issues for opioid-dependent women during the perinatal period. Journal of Psychoactive Drugs 1991;23:191-201.
Kreek M, Schecter A, Gutjahr C, Bowen D, Field F, Queenan J, et al. Analyses of methadone and other drugs in maternal and neonatal body fluids: use in evaluation of symptoms in a neonate of mother maintained on methadone. American Journal of Drug and Alcohol Abuse 1974;1:409.
Pond S, Kreek M, Tong T, Raghunath J, Benowitz NL. Altered methadone pharmacokinetics in methadone-maintained pregnant women. Journal of Pharmacology and Experimental Therapeutics 1985;233:1-6
In This Section
- Certificate Programs
- Methadone Research Web Guide
- Acknowledgments
- Introduction
- Part A
- Part B
- Question 1: Is methadone maintenance treatment effective for opioid addiction?
- Question 2: Does methadone maintenance treatment reduce illicit opioid use?
- Question 3: Does methadone maintenance treatment reduce HIV risk behaviors and the incidence of HIV infection among opioid-depen
- Question 4: Does methadone maintenance treatment reduce criminal activity?
- Question 5: Does methadone maintenance treatment improve the likelihood of obtaining and retaining employment?
- Question 6: What effect can methadone maintenance treatment have on the use of alcohol and other drugs?
- Question 7: What components of methadone maintenance treatment account for reductions in AIDS risk behaviors?
- Question 8: Do risk factors for HIV infection acquisition and transmission differ for women compared with men in methadone maint
- Question 9: Is methadone maintenance treatment effective for women?
- Question 10: Is methadone safe for pregnant women and their infants?
- Question 11: Is it necessary to reduce methadone dose or detoxify women from methadone during pregnancy to protect the f
- Question 12: Is the long-term use of methadone medically safe, and is it well tolerated by patients?
- Question 13: Are there program characteristics associated with the success of methadone maintenance treatment?
- Question 14: Are there patient characteristics associated with the success of methadone maintenance treatment?
- Question 15: Are there cost benefits to methadone maintenance treatment?
- Question 16: What are the retention rates for methadone maintenance treatment?
- Question 17: Is mandated methadone maintenance treatment as effective as voluntary treatment?
- Question 18: What is the role of L-alpha-acetyl-methadol (LAAM)?
- Question 19: How do buprenorphine and methadone compare?
- Question 20: Can methadone and buprenorphine be abused?
- Part C
- Part D
- Methadone Research Web Guide Tutorial
- Questions: Methadone Research Web Guide
- Answers: Methadone Research Web Guide
- Methadone Research Web Guide
- Degree Programs
- Virtual Lectures
- Research Publications
Important Dates
NIDA International Forum
June 14–17, 2013
Online Registration Deadline:
May 6, 2013
FELLOWSHIPS
IAS/NIDA Fellowships
Application Deadline:
February 10, 2013
NIDA International Program Fellowships
Application Deadline:
April 1, 2013
Global Health Program for Fellows and Scholars
Application Deadlines: Vary
GRANTS
Brain Disorders in the Developing World: Research Across the Lifespan
(Non-AIDS)
R01 PAR-11-030and R21 PAR-11-031
Application deadline:
February 14, 2013
MEETINGS
American Association for the Advancement of Science
February 14–18, 2013
Boston, Massachusetts, USA
International Drug Abuse Research Society (IDARS)
April 15–19, 2013
Mexico City, Mexico
2013 International Conference on Global Health: Prevention and Treatment of Substance Abuse and HIV
April 17–19, 2013
Taipei, Taiwan
Yih-Ing Hser, Ph.D.