ARE INFANTS EXPOSED TO METHADONE IN UTERO AT AN INCREASED RISK FOR MORTALITY?

Main Article Content

Lauren E Kelly
Michael J Rieder
Karen Bridgman-Acker
Albert Lauwers
Parvaz Madadi
Gideon Koren

Keywords

Methadone, pregnancy, mortality, infant

Abstract

Background


The prevalence of opioid abuse is increasing in North America. Opioid abuse during pregnancy can cause medical, obstetric and psychosocial complications. Neonates exposed to opioids in utero often develop the neonatal abstinence syndrome. Methadone maintenance therapy is the treatment of choice for maternal opioid dependency. There have been unsupported concerns that infants cared for by mothers treated with methadone have higher mortality rates during the first year of life than in the general population.


 


Objectives


To compare the mortality rates of infants exposed to methadone in utero to those of general population in Ontario, Canada.


 


Methods


We utilized several provincial and national databases including those of the Office of the Chief Coroner of Ontario, the Canadian Institute for Health Information, and the Ontario Infant Mortality Rate Report. Reference organ weights were obtained from the peer reviewed literature.


 


Results


The Office of the Chief Coroner of Ontario has reported 8 deaths in children under one associated with in utero methadone exposure between January 1, 2006 and December 31, 2010. Over the same period there have been a total of 1103 cases of neonatal abstinence syndrome recorded in the province. The mean infant mortality rate in Ontario for children under the age of 1year over the same period was 5.2 per 1000 live births. The odds ratio for mortality among children with neonatal abstinence syndrome was not different from that in the general population [OR 1.45 (95% confidence interval 0.471-4.459)] (p=0.56).


 


Conclusion


The available data do not support the concerns that children under the age of one year, born to mothers on methadone maintenance therapy (MMT) are at an increased risk for mortality.

Abstract 281 | PDF Downloads 130

References

1. College of Physicians and Surgeons of Ontario (CPSO). Avoiding Abuse, Achieving a Balance; Tackling the Opioid Public Health Crisis (2010). Available at: http://www.cpso.on.ca/uploadedFiles/policies/posit ions/Opioid%20report%20final.pdf. Accessed on September 20, 2011
2. de Castro A, Jones HE, Johnson RE, Gray TR, Shakley DM, Huestis MA. Methadone, Cocaine, Opiates, and Metabolite Disposition in Umbilical Cord and Correlations to Maternal Methadone Dose and Neonatal Outcomes. Ther Drug Monit 2011:33;443-452
3. Kuczkowski KM. DrugMisuse in Pregnancy. Br J Psychiat 2004:184;182-187
4. Hart, Anton et al. Report of the Methadone Maintenance Treatment Practices Task Force (2007) Available at: http://www.health.gov.on.ca/english/public/pub/mi nistry_reports/methadone_taskforce/methadone_ta skforce.pdf. Accessed September 1, 2011
5. Hunt RW, Tzioumi D, Collins E, Jeffery HE. Adverse neurodevelopmental outcome of infants exposed to opiate in-utero. Early Hum Dev2008:4;29-35
6. Cleary BJ, Donnelly J, Strawbridge J, Gallagher PJ, Fahey T, Clarke M, Murphy DJ. Methadone Dose and Neonatal Abstinence Syndrome – Systematic Review and Meta-Analysis. Addiction 2010: 105;2071-2084.
7. Bell GL, Lau K. Perinatal and neonatal issues of substance abuse. Pediat Clin of N Amer 1995:42;261-81.
8. Finnegan LP, Kron RE, Connaughton JF, Emich JP. Assessment and treatment of abstinence in the infant of the drug-dependent mother. In J Clin Pharmacol Biopharm 1975:12:19-32.
9. Provincial Council for Maternal and Child Health (PCMCH): Maternal Newborn Advisory Committee NAS Report (2012).Available at: http://pcmch.on.ca/ClinicalPracticeGuidelines/Neo natalAbstinenceSyndrome.aspx Accessed on March 3, 2012.
10. Canadian Institute for Health Information (CIHI): MIS standards. Available at: http://www.cihi.ca/CIHI-ext portal/internet/EN/TabbedContent/standards+and+ data+submission/standards/mis+standards/cihi010 691 Accessed onMarch 3, 2011.
11. Statistics Canada. Infant mortality rates, by province and territory, 2007. Available at: http://www40.statcan.ca/l01/cst01/health21aeng. htm Accessed on September 10, 2011.
12. Statistics Canada, Vital Statistics and Deaths Database, 2008. Available at: http://www.statcan.gc.ca/cgibin/imdb/p2SV.pl?Fu nction=getSurvey&SDDS=3233&lang=en&db=i mdb&adm=8&dis=2 Accessed on September 10, 2011.
13. Coppoletta JM, Wolbach SB. Body length and organ weights of infant and children. Am J Patholy 1932:9;55-70.
14. Shankle WR, Landing BH, Gregg J. Normal organ weights of infants and children. Fetal Pediatr Pathol 1983:1;399-408
15. American Academy of Pediatrics (AAP). Technical Report: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2011: 128;e1134-1367.
16. McKenna JJ, McDade T.Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bed sharing and breast feeding. Paedc Resp Rev 2005:6;134-152.
17. Byard RW, Beal S, Bourne AJ. Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood. Arch Dis Child 1994:71;497-500
18. College of Physicians and Surgeons of Ontario (CPSO).Methadone Maintenance Treatment Program Standard and Clinical Guidelines (2011). Available at: http://www.cpso.on.ca/uploadedFiles/policies/guid elines/methadone/Meth%20Guidelines%20_Oct07 .pdf Accessed on September 23, 2011.
19. Darke S, Duflou J, Torok M. The comparative toxicology and major organ pathology of fatal methadone and heroin toxicity cases. Drug Alcohol Dependence 2010:106;1-6.
20. Siebert JR, Haas JE. Organ weights in sudden infant death syndrome. Fetal Ped Patholy 1994:14 ;973-985.
21. Smylie J, Fell D, Ohlsson A, and the Joint Working Group on First Nations, Indian, Inuit and Metis Infant Mortality of the Canadian Perinatal Surveillance System: A Review of Aboriginal Infant Mortality Rates in Canada: Striking and Persistent Aboriginal/Non-Aboriginal Inequalities. Canadian J Public Health 2010:101(2);143-148.

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 7 8 9 10 > >>