Methadone is a long-acting opioid used in the treatments of opioid addictions and chronic pain. In pregnant mothers, the beneficial use of methadone must be weighed against the risks on an individual basis and while it is not recommended to stop using methadone once pregnancy begins, the medication does flow through the blood to the fetus and requires extensive medical supervision in its use. The following are some considerations about taking methadone during pregnancy.
Methadone Use in MAT
According to the SAMHSA, “In 1998, a National Institutes of Health consensus panel recommended methadone maintenance as the standard of care for pregnant women with opioid addiction.” In this context, taking methadone during pregnancy reduces the associated harms of short-acting opioid dependencies such as withdrawals or overdoses in the mother and the fluctuations in the opioid levels in the maternal serum to protect the fetus from repeated withdrawals and the high opioid levels that lead to miscarriage, premature birth, or other neonatal complications.
In the 1970’s a low dose approach of methadone was used in MAT to avoid neonatal abstinence syndrome or withdrawals, but, those studies are contradicted today. In more recent studies, according to the SAMHSA, ” higher dosages have been associated with increased weight gain, decreased illegal drug use, and improved compliance with prenatal care by pregnant women in MAT and with increased birth weight and head circumference, prolonged gestation, and improved growth of infants born to women in MAT.”
Reducing other Associated Harms
Taking methadone during pregnancy can reduce a great deal of other associated harms to mothers who are addicted to opioids. Methadone staves off cravings and withdrawals for short-acting opioids allowing the mother to have a greater sense of calmness about doing the right things for her unborn child. No more need to get involved in criminal or dangerous activities to obtain and use drugs and mothers tend to comply more readily with reduction in IV use and poly-substance abuse.
Pregnant mothers are at risk of high blood pressure, anemia, gestational diabetes, and other complications that require appropriate care. Taking methadone during pregnancy can reduce some of the negative factors that affect the child when the mother complies with treatment regimens and medical advice. According to the NIDA, ” it is often difficult to tease apart the confluence of factors that go with drug abuse during pregnancy—poor nutrition, inadequate prenatal care, stress, and psychiatric comorbidities—all of which may impact fetal development.”
Methadone and the Newborn
Because methadone is an opioid drug, when the child is born, they too, will eventually go through withdrawals, but, in the proper scenario of care, the withdrawals can be mitigated with a gradual tapering of opioids determined by the infant’s progress. Mothers who intend to breast feed will pass on minimal amounts of methadone that make the weaning less difficult, but, for mothers who are infected with HIV, breastfeeding is not advised.