Timing of methadone treatment for pregnant women does not increase health risks: study

By Michael Oliveira

A new study has found that women who began methadone maintenance therapy (MMT) during later stages of pregnancy did not have increased risks of many perinatal adverse health outcomes compared to pregnant women who initiated the treatment for opioid use disorder earlier. However, it also found that perinatal adverse events were generally higher among women treated with MMT compared with the general population, and that later initiation of methadone was associated with a risk of children being discharged from hospital to social services.

Methadone prevents intoxication and withdrawal with continuous daily dosing, which helps create a healthier environment in which a fetus can grow. Studies have shown that babies of mothers receiving MMT tend to have fewer complications than babies whose mothers had an untreated opioid use disorder.

“Although this study suggests that methadone treatment is a safe option regardless of when it is started in pregnancy, it also highlights that women with opioid use disorders and their children are vulnerable to serious clinical adverse events,” said senior author Dr. Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences.

“Furthermore, women with an opioid use disorder may be avoiding prenatal care because of a fear of losing custody of their children, which puts both their health and that of their child at higher risk. This is supported by previous research showing that pregnant women with opioid use disorder often forgo their psychiatric and primary-care appointments in an attempt to retain guardianship of their unborn child.

“It is therefore imperative that we find a way to make our health-care system more welcoming and accepting of women with opioid use disorders to reduce the stigma and fear experienced by this already marginalized population.”

The study, which was based on an analysis of nearly 2,000 babies whose mothers were treated with publicly funded methadone during pregnancy, suggests that more work is needed to assess long-term outcomes and to investigate barriers to health-care access among pregnant women with opioid use disorders.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.