Browsing by Subject "methadone"

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    Stereoselective Analysis of Methadone and EDDP in Laboring Women and Neonates in Plasma and Dried Blood Spots and Association with Neonatal Abstinence Syndrome
    (Thieme, 2021) Metzger, Ingrid F.; Thomas, Anna E.; Evrard, Cindy A.; Jones, David R.; Masters, Andrea R.; Haas, David M.; Haneline, Laura S.; Quinney, Sara K.; Obstetrics and Gynecology, School of Medicine
    Objective This pilot study evaluated the relationship between maternal and neonatal R- and S-methadone and R- and S-2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) exposure and the severity of neonatal abstinence syndrome (NAS). The use of dried blood spots (DBS) as an alternative for plasma in assessing methadone and EDDP was also assessed. Study Design Women receiving methadone for medication assisted treatment of opioid use disorder during pregnancy were eligible for recruitment. Plasma and DBS samples were collected from mothers during labor, from cord blood, and from newborns during genetic screen. R-/S-methadone and EDDP were measured by high-performance liquid chromatography tandem mass spectrometry (HPLC/MS/MS). Associations between methadone exposure, neonatal morphine requirements, and severity of NAS were examined. Results Twenty women and infants completed the study. Maternal methadone dose at delivery was 112 mg/day (range = 60–180 mg/day). Sixteen neonates experienced NAS requiring morphine; three also required phenobarbital. Higher cord blood concentrations of R-methadone, R- and S-EDDP were associated with higher maximum doses of morphine (p < 0.05). Conclusion Maternal methadone and cord blood concentration at delivery are variable and may be potential markers of neonatal abstinence syndrome.
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    Treatment of Opioid Use Disorder During Pregnancy: Buprenorphine or Methadone?
    (2020-03) Davis, Elizabeth; Owusu, Raiven; Vinze, Sanjna; Arnaduo, Camilla
    BACKGROUND: In 2011, 5% of pregnant women 15 to 44 yo reported opioid/illicit drug use during pregnancy, and this percentage is rising. Opioid use disorder (OUD) is a chronic disease associated with adverse effects on maternal and fetal health, such as physiologic withdrawal at birth, low birth weight, congenital abnormalities, and higher relapse rates. Pregnant women treated for OUD with medication-assisted-treatment (MAT) have significantly reduced adverse effects. MAT is the standard treatment of OUD in along with counseling/therapy. Opioid agonists, namely buprenorphine and methadone, are common treatments, as they prevent opioid withdrawal symptoms, improve adherence to prenatal care, and reduce the risk of relapse. CASE: Patient is a 26 year old G2P1 female presenting with buprenorphine, heroin, and methamphetamine use during pregnancy. She had a vaginal delivery of a healthy baby girl at 40+2 weeks (APGARs 8 and 9). She used heroin during the first trimester of pregnancy and started buprenorphine treatment at 5 months’ gestation. Pregnancy complicated by a 3 weeks in a rehab center at 8 months following relapse on methamphetamine. CLINICAL SIGNIFICANCE: Research is being conducted on the risks and benefits of buprenorphine vs methadone as MAT. Buprenorphine overall has better maternal and neonatal outcomes when compared to methadone. Mothers taking buprenorphine during their pregnancy were more likely to start MAT prior to or earlier in pregnancy and had longer gestations compared to methadone. In regards to neonatal outcomes, methadone has been associated with higher rates of neonatal mortality and congenital anomalies when compared to buprenorphine. NAS generally is less severe with buprenorphine, and newborns require treatment significantly less often and for a shorter duration. Newborns exposed to buprenorphine are associated with greater birth weight but more gastrointestinal abnormalities. With the increase in OUD during pregnancy, research regarding the most effective MAT is timely and critical.