Maintenance agonist treatments for opiate dependent pregnant women

Back ground The prevalence of opiate use among pregnant women ranges from 1% to 2% to as much as 21%. Heroin crosses the placenta and pregnant opiate dependent women experience a six fold increase in maternal obstetric complications such as low birth weight, toxaemia, 3rd trimester bleeding, malpresentation, puerperal morbidity, fetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neurobehavioral problems, increased neonatal mortality and a 74- fold increase in sudden infant death syndrome. Objectives To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions on child health status, neonatal mortality, retaining pregnant women in treatment, and reducing use of substances Search strategy We searched Cochrane Drugs and Alcohol Group' Register of Trials ( June 2007), PubMed ( 1966 - June 2007), CINAHL ( 1982- June 2007), reference lists of relevant papers, sources of ongoing trials, conference proceedings, National focal points for drug research. Authors of included studies and experts in the field were contacted. Selection criteria Randomised controlled trials enrolling opiate dependent pregnant women Data collection and analysis The authors assessed independently the studies for inclusion and methodological quality. Doubts were solved by discussion. Main results We found three trials with 96 pregnant women. Two compared methadone with buprenorphine and one methadone with oral slow morphine. For the women there was no difference in drop out rate RR 1.00 ( 95% CI 0.41 to 2.44) and use of primary substance RR 2.50 ( 95% CI 0.11 to 54.87) between methadone and buprenorphine, whereas oral slow morphine seemed superior to methadone in abstaining women from the use of heroin RR 2.40 ( 95% CI 1.00 to 5.77) For the newborns in one trial buprenorphine performed better than methadone for birth weight WMD - 530 gr ( 95% CI - 662 to 397), this result is not confirmed in the other trial. For the APGAR score both studies didn't find significant difference. No differences for NAS measures used. Comparing methadone with oral slow morphine no differences for birth weight and mean duration of NAS. The APGAR score wasn't considered. Authors' conclusions We didn't find any significant difference betewen the drugs compared both for motheranf for child outcomes; the trials retrieved were too few and the sample size too small to make firm conclusion about the superiority of one treatment over another. There is an urgent need of big randomized controlled trials.