Methadone maintenance versus implantable naltrexone treatment in the pregnant heroin user
Hulse, G. K., O'Neil, G., & Arnold-Reed, D. E. (2004). Methadone maintenance versus implantable naltrexone treatment in the pregnant heroin user. International Journal of Gynecology and Obstetrics, 85(2), 170-171. doi:10.1016/j.ijgo.2003.10.001
Maternal heroin use during pregnancy is associated with significant risks to both mother and neonate, including decreased neonatal birth weight and increased neonatal mortality . To date, methadone maintenance treatment (MMT) has been the treatment of choice for the pregnant heroin user [1 and 2]. Naltrexone implant treatment (NIT) has also undergone a trial as a management strategy with pregnant heroin users .
This brief communication reports obstetric and neonatal outcomes of 17 pregnant women who were managed with NIT (16 who conceived while on implant treatment) compared with 90 women who were managed with MMT. Obstetric and neonatal outcomes for the two groups were compared with each other and separately to national norms in Australia.
Mean (±S.D.) gestation age associated with NIT [38.6 weeks (±1.55)] was not significantly different from that observed with MMT [38 weeks (±2.1)]. There were, however, significantly more deliveries of <37 weeks of gestation amongst MMT compared with national data. In>contrast, the proportion of deliveries <37 weeks of gestation for NIT-managed women did not differ significantly from national data>(Table 1).
The mean (±S.D.) birth weight for infants whose mothers were managed by MMT (2888±533 g) and NIT (3037±428 g) were not significantly different. There were, however, significantly more neonates born of low birth weight in the MMT group compared with national data. In contrast, the proportion of neonates born of low birth weight amongst NIT-managed women did not differ significantly from the national mean (Table 1).
The mean (±S.D.) APGAR score at 1 min for NIT-managed patients (9±0) was significantly better than that of their MMT counterparts (7.9±1.54). Five-minute APGAR scores for the NIT (9.17±0.39) and MMT (8.97±0.8) groups were not significantly different. The variance in infant APGAR score at both 1 and 5 min amongst MMT-managed women was also statically greater when compared with infants whose mothers were treated with NIT. This reflects consistently better postnatal adjustment for neonates born to NIT women.
Exposure to low dose naltrexone delivered via implant treatment throughout much of the pregnancy was not associated with apparent negative outcomes for either mother or neonate. This result is similar to those previously reported for pregnant heroin-dependent women managed by oral and NIT [3 and 4].
The authors conclude that NIT may offer an alternative and more beneficial method of management than MMT for the pregnant heroin-dependent patient who finds it difficult to shift away from dependent heroin use patterns.
naltrexone implants, methadone maintenance, heroin use, pregnancy