| A. |
Possible effects on reproduction and fertility |
|
| 1. |
After one year or more of stable methadone
maintenance, fertility returns to normal baseline levels |
|
| B. |
Methadone maintenance for pregnant,
opioid-dependent women provides |
|
| 1. |
Reduction of illegal opioid/other drug use |
| 2. |
Removes mother from the drug-seeking environment
|
| 3. |
Eliminates the necessary illegal behavior |
| 4. |
Prevents daily fluctuations of the maternal drug
level |
| 5. |
Improves maternal nutrition, thus increasing
fetal birth weight |
| 6. |
Leads to more consistent prenatal care |
| 7. |
Enhances |
|
| a. |
Preparation for the birth of the infant |
| b. |
Homemaking |
|
| 8. |
Reduces obstetrical complications |
| 9. |
Reduces risk of HIV infection |
|
| C. |
Effects on the developing fetus |
|
| 1. |
Infants show more normal birthweights compared
to babies born to heroin- using mothers |
|
| D. |
Effects in the course of pregnancy |
|
| 1. |
If patient is in a managed methadone maintenance
treatment program (MMTP) and is not taking street drugs, methadone treatment improves
perinatal outcome (compared to heroin use) |
|
| E. |
Methadone dosing strategy |
|
| 1. |
Initial oral dose to reverse opioid abstinence
symptoms as quickly as possible |
|
| a. |
Additional doses repeated until signs of
withdrawal not present |
|
| 2. |
Adjust dose by 5 to 10 mg daily based on
signs/symptoms of withdrawal |
| 3. |
Once stabilization level established, keep at
that level for several days |
| 4. |
If polydrug dependence, concurrent medical
procedures should be initiated |
|
| F. |
Labor and delivery |
|
| 1. |
Patients may have lower pain thresholds and may
not respond to narcotics in usual doses; they are excellent candidates for epidurals |
| 2. |
Narcan is contraindicated as it may
produce severe withdrawal |
|
| G. |
Postpartum |
|
| 1. |
Lactation |
|
| a. |
Breast feeding is not contraindicated for
children of methadone-maintained mothers if mothers are not polydrug users and if they are
HIV negative |
| b. |
While very small amounts of methadone can be
passed from mother to infant via breast milk, the advantages of breast feeding, both for
mother and infant, far outweigh the disadvantages |
|
| 2. |
Child |
|
| a. |
Narcan is contraindicated |
| b. |
Neonatal Methadone Abstinence Syndrome |
|
| • |
Is typically more severe than that of heroin |
| • |
Usually occurs within the first 2-3 days after
birth |
| • |
Late withdrawal can occur at 2 to 3 weeks of age
|
| • |
Subacute withdrawal can persist until 6 months
of age |
| • |
Typical CNS withdrawal symptoms such as
high-pitched crying; frantic fist sucking; searchingfor food; a high level of arousal with
muscle hypertonia; seizures can be late occurring, peak at about 7 to 14 days and occur in
about 5 percent of methadone-exposed babies |
|
| c. |
Reduced perinatal mortality |
| d. |
Low birth weight involving fetal weight, length
and head circumference |
| e. |
Seizures |
| f. |
Thrombocytosis (increase in the number of
platelets in the blood) |
| g. |
Hyperthyroid state |
| h. |
Sudden Infant Death Syndrome |
|
| • |
About 3 to 4 times higher than in the general
population |
|
| i. |
Delayed effects |
| j. |
No effect |
|
|
| H. |
Treatment protocol for opiate-exposed infants |
|
| 1. |
Systematic examination for signs of neonatal
abstinence syndrome |
| 2. |
Pharmacological interventions |
|
| a. |
Paregoric |
|
| • |
Decreases seizure activity |
| • |
Increases sucking coordination |
| • |
Decreases the incidence of explosive stools |
|
| b. |
Phenobarbital |
|
| • |
May be especially helpful in cases of polydrug
abuse |
|
|
| 3. |
Modification of the infant's environment |
|
| a. |
Place the infant in a dimly lit, quiet room |
| b. |
Swaddling |
| c. |
Use of a nonoscillating waterbed |
| d. |
Comfort in a prone or lateral position |
|
| • |
There is ongoing debate over prone versus supine
positioning as possible factors in SIDS |
|
|
|
University of Nevada, Reno
