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Pregnant… on Methadone Maintenance!

If you qualify under the above title, then you don’t need an explanation of what it describes. However, if you are perhaps just curious about this issue, you may find the following brief description useful. Regardless of whether methadone is part of your circumstance, if you have recently discovered you are (or think you might be) pregnant, we hope that after finishing the article you’ll continue reading for more information about Avenue Women’s Center and our care for every woman who faces concerns about her unplanned pregnancy..

Avenue Women’s Center serves Chicagoland women as they navigate the challenges, questions and choices connected with an unintended pregnancy. We offer nonjudgmental, confidential and compassionate care through our experienced client advocates. Many of our services, including a professional-grade pregnancy test, 99.5% accurate just ten days after the possible time of conception, are free. Also free to you is a private, no-obligation pregnancy consultation. Consultations are tailored to meet the needs of each individual client. Some women are moving towards terminating a pregnancy. Other women are exploring whether their best decision might include continuing the pregnancy. Wherever you find yourself – regardless of whether or not methadone maintenance is part of your experience – if you would benefit from the listening ear, accurate information and support of someone a bit removed from your situation, please contact us for the caring assistance so critical to you at this time.

What is Methadone and Methadone Maintenance?

Withdrawal from narcotic use is associated with a number of very unpleasant experiences; nausea, diarrhea, muscle aches, sweating, irritability, insomnia, “crawly” skin, anxiety, to name a few. It is primarily because of these experiences that people become addicts. They learn quickly that continuing the use of the drug makes it possible for them to avoid these unpleasant symptoms of the withdrawal. Of course, as active addicts they encounter many more severe and potentially life-threatening problems.

These problems can be avoided through the use of a procedure called methadone maintenance. Methadone is a synthetic opiate analog (similar structure and function) that has been in use successfully for many decades in the treatment of opiate addiction. It has the advantage of being less addictive than natural opiates (morphine, heroin) and its withdrawal symptoms tend to be less severe and generally more tolerable. In addition, maintenance levels of methadone (which can be taken orally) will allow the individual to avoid the typical effects of opiate withdrawal over extended periods of time…and it is there we need to begin a discussion of the issue of being pregnant while on methadone maintenance.

What about Pregnancy and Methadone Maintenance?

A woman who is pregnant and dependent on opiates never has an ideal situation, but an acceptable outcome can be achieved if she follows some common-sense rules during her pregnancy. First, it is never recommended that a pregnant woman on methadone maintenance therapy attempt to withdraw from opiate addiction during her pregnancy. Stopping methadone during the pregnancy can be harmful to the woman as well as to the pregnancy. Many medical professionals are in agreement that the best option for a pregnant woman with opioid addiction is medication-assisted therapy (MAT).

Methadone is commonly used for the treatment; a newer option, buprenorphine is another drug which may be given. Each of these is a long-acting opioid, meaning they stay active in the body for a long time. They reduce cravings, and they do so without causing the pleasant feelings generated by other addictive opioids. They are designed to minimize the negative effects of addiction withdrawal without increasing the desire to return to the opioid.

Throughout the treatment, most pregnant women will be under the care of both an obstetric clinician and a substance use counselor. Both will be working to ensure that the pregnancy results in the live birth of a baby that will grow into a normal adult. The woman will see her drug counselor regularly for maintenance doses of methadone. Those visits cannot be missed. Although her obstetric visits are less time critical, the clinician will need to assure that the pregnancy is progressing normally—and to intercept any difficulties that may arise.

The MAT treatment has been shown to reduce pregnancy complications. With either methadone or buprenorphine, it is more likely that the pregnancy will progress routinely. There is less concern, also, of early preterm birth. Neither of the medicines has been found to cause birth defects.

Some infants born to women taking opioids (including the treatment drugs methadone or buprenorphine) can have temporary withdrawal symptoms. This condition is called neonatal abstinence syndrome (NAS). As it is a possibility, the newborn is monitored for symptoms. NAS is highly treatable and evidence has shown it does not lead to long-term complications. Simple actions such as swaddling, skin-to-skin contact, and sometimes short-term medications will reduce the temporary effects of NAS. As they grow, the babies should go on to develop normally and usually end up in the normal range for size and development.

Both methadone and buprenorphine have been shown to work well for a woman’s MAT treatment; one recent trial indicated the buprenorphine may be better for the baby. It was observed that withdrawal symptoms were milder for infants born to women who had used buprenorphine, and these babies required a shorter hospital stay for treatment. A woman should discuss with her doctor what the better option is for her situation.

Although pregnancy and methadone maintenance is not a topic that impacts all of our clients, we felt it important to give it some attention here. Our staff does not include medical specialists in the MAT treatment for a continuing pregnancy. However, we ARE specialists in understanding that every woman’s situation is unique. Options must be explored and decisions must be made. Along the way, women need to receive accurate information and caring support. That is what our compassionate specialists provide.

At Avenue Women’s Center it is our commitment to meet each client – to meet you – in whatever your circumstance and to walk with you as you navigate the path ahead. We hope you will find our offices to be conveniently located – in Elmhurst, Glen Ellyn / Lombard, Naperville, West Chicago, and Wood Dale, Illinois. Please let your next step be to reach out to us by call, text, email, or chat. We will be honored to assist as you make private decisions about terminating or continuing a pregnancy… and as you move forward with confidence in your best plan.


References:

  • American College of Obstetricians and Gynecologists. (2016, May). ACOG Statement on Opioid Use During Pregnancy. Retrieved from: https://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Opioid-Use-During-Pregnancy
  • American College of Obstetricians and Gynecologists. (2017, August). Tobacco, Alcohol, Drugs, and Pregnancy FAQ. Retrieved from: https://www.acog.org/Patients/FAQs/Tobacco-Alcohol-Drugs-and-Pregnancy#opioids
  • National Center for Biotechnology Information (NCBI), PubMed. (2012, May). ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22525931
  • American College of Obstetricians and Gynecologists. (2017, August) . ACOG Committee Opinions: Opioid Use and Opioid Use Disorder in Pregnancy. Retrieved from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy
  • ASAM (American Society of Addiction Medicine) Pamphlet: Providers Clinical Support System for Opioid Therapies (PCSS-O). PREGNANCY: Methadone and Buprenorphine. Retrieved from: http://pcss-o.org/wp-content/uploads/2015/10/WAGBrochure-Opioid-Pregnancy_Final.pdf
  • Methadone and Pregnancy. Methadone and Pregnancy. Retrieved from: http://www.methadoneandpregnancy.com/?page_id=46
  • Addiction Blog. (2011, January). The effects of methadone treatment during pregnancy. Retrieved from: http://drug.addictionblog.org/the-effects-of-methadone-treatment-during-pregnancy/

Reviewed by Patricia Kuenzi, APN-CNP, MSN, ANP, PNP.

The information provided here is general in nature.  It is not a substitute for a consultation with a medical professional. Before any medical procedure, it is imperative that you discuss your personal medical history, risks, and concerns with your doctor. If you have questions during or after a procedure, your doctor should be immediately contacted. Avenue Women’s Center is not an emergency center.  If you are experiencing severe symptoms, such as bleeding and/or pain, seek immediate medical attention.  Contact your physician, go to an emergency room, or call 911.

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