Opioid Abuse and Dependence in Pregnancy: Impact on Obstetrical Outcomes

In a recent study, researchers looked at the rising nationwide trend of opioid abuse and dependence in pregnancy and obstetrical outcomes in this patient population.  Previous research has focused on neonatal outcomes, such as neonatal abstinence syndrome; however, maternal complications have not been well-studied.  In this study, data was collected from the Nationwide Inpatient Sample (NIS), including nearly 57 million American women who were admitted for obstetric delivery between the years 1998-2011.  Overall 113,105 of those women (0.2%) were identified as abusing or being dependent on opioids.  The prevalence increased by 127% from the beginning of the study in 1998 until its completion in 2011, reflecting the growing opioid epidemic.   The increase was mostly represented in women 20 to 34 years or age.

Methadone and Breastfeeding

Up until 2001, the American Academy of Pediatrics (AAP) recommended that methadone was compatible with breastfeeding in women taking less than 20 mg per day.  Because most women on methadone maintenance therapy typically require 50 to 15o mg of methadone per day during pregnancy, this meant that most women on methadone were not able to breastfeed. However, the dose restriction for methadone was eliminated in 2001, a decision driven by several studies indicating that the levels of methadone secreted into human breast milk were relatively low.