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Ask an Expert: I'm Pregnant and on Methadone

Published date : October 14, 2018

One'bottom-line' question frequently asked by mothers and fathers is whether intrauterine methadone or buprenorphine exposure has some long-term impact on child growth. We are equally methadone and very fearful of what could happen when our baby is born. Can you offer any insight on what we shoul-

or buprenorphine exposure has some long-term impact on child growth. We are equally methadone and very fearful of what could happen when our baby is born. Can you offer any insight on what we should expect? Thank you. Dr. Jeffrey Junig: First, know that you're doing the perfect thing by staying in medication-assisted therapy (MAT) during your pregnancy. Doctors tend to be tempted to discontinue opioids to avoid the issues that arise at shipping, but the science on that issue has been settled. Tapering during pregnancy raises the risk of relapse, which would put mother and infant in danger. Even in the absence of migraines, the withdrawal symptoms through tapering can interfere with healthy nourishment, hydration, and sleep which are important for esophageal development. Sponsored ad Infants born to mothers around MAT may experience withdrawal symptoms that can include coughing, yawning, insomnia, spasticity, as well as seizures in acute cases. The indicators are referred to as neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS). Most infants exposed to methadone in-utero show symptoms of NAS beginning soon after shipping. A milder and postponed form of NAS occurs in roughly half of the babies born to mothers on buprenorphine. NAS symptoms brought on by buprenorphine are delayed, so infants born to mothers on MAT are often held for monitoring up to ten days in the absence of symptoms. Physicians and hospitals have a selection of approaches to NAS. Some doctors make it possible for mothers to take their babies home and return when symptoms develop. My sense is that more hospitals and doctors are holding infants at risk for NAS for 5-10 days, with one of several screening tools to track the intensity of symptoms. If present, symptoms of NAS are handled by encouraging breast feeding (which offers a little bit of buprenorphine or methadone), increasing mother/baby contact, swaddling, and with opioid and non-opioid drugs. Again, there is significant variation from 1 hospital to the next, and methadone, morphine, or buprenorphine are generally utilized when opioid tapers are necessary. In the past couple years there's been a tendency toward greater use of the non-pharmacologic interventions mentioned above, which reduce the need for opioids. I will not address legal issues apart from imagining that CPS frequently becomes involved in cases of NAS once they are contacted by physicians, hospital employees, or nurses. Most healthcare professionals are covered by mandatory reporting legislation in the event of child abuse, and investigations may be initiated by (assumedly) well-intending individuals. I am sure the CPS agencies vary greatly in their interest and participation in various regions. One'bottom-line' question frequently asked by mothers and dads is if intrauterine methadone or buprenorphine vulnerability has some long-term effect on child development. There have been several studies with varying results (although most individual studies seem to demonstrate no important differences in cognition or behavior), but we do not conclusively know the reply to this. People and other factors likely affect the effects of methadone. There's also overlap between methadone and non-methadone-exposed children, i.e. there are high and low outcome measures in subjects from both teams. The message is that if methadone has an effect on development isn't clear, but any possible effect is minimized by taking care to steer clear of different behaviors that can affect development.