heroin and Birth-Weight

AIMS/DESIGN: Reduction in mean birth weight and increased incidence of low birth weight are both associated with exposure to illicit heroin in pregnancy. Many studies examining neonatal outcomes in pregnant heroin users treated with methadone report improvements in birth weight. As a consequence, methadone treatment has become the 'gold standard' for the management of the pregnant heroin user. However, not all studies report significant birth weight increases associated with methadone. We undertook a number of meta-analyses on reduction in mean birth weight and incidence of low birth weight to estimate more precisely the effect of illicit heroin and methadone.. Results showed mean reduction in birth weight associated with heroin use: 489 g (95% CI 284-693 g), compared with methadone: 279 g (229-328 g). Similarly, the pooled relative risk estimate for low birth weight for maternal heroin use was 4.61 (95% CI 2.78-7.65), compared with 1.36 (0.83-2.22) for methadone. Analysis of data on combined heroin and methadone use produced a pooled mean reduction in birth weight of 557 g (403-710 g), with a pooled relative risk estimate for low birth weight of 3.28 (2.47-4.39). Pooling 'any' methadone data, regardless of heroin use, produced an estimated reduction in birth weight of 395 g (311-478 g) and a relative risk estimate for low birth weight of 1.90 (1.29-2.81). Combining all data in an 'any' opiate use analysis also produced a mean reduction in birth weight of 483 g (386-583 g) and a relative risk estimate for low birth weight of 3.81 (2.57-5.65).. The current findings suggest that heroin use while receiving methadone may counteract the birth weight advantage gained from methadone alone. Whether this is due to fetal exposure to heroin plus methadone, to reduced antenatal care, other behavioural and environmental factors associated with concurrent use of heroin and methadone or a combination of these is unclear. Nevertheless, these results challenge the current belief that the pregnant user is always better off receiving methadone than not, and suggests that methadone may not be the appropriate treatment for the pregnant women who continue to use illicit heroin.

Topics: Birth Weight; Female; Heroin; Humans; Infant, Low Birth Weight; Infant, Newborn; Methadone; Opioid-Related Disorders; Pregnancy; Pregnancy Complications

In order to investigate the effects of exposure to buprenorphine compared with methadone during pregnancy, a prospective multicenter study was conducted in collaboration with maternity hospitals, maintenance therapy centers, and general practitioners involved in addiction care. Ninety pregnant women exposed to buprenorphine and 45 to metadone were selected for the study.. During pregnancy, some women were exposed to illicit agents: cannabis (42% in the buprenorphine group vs. 58% in the methadone-treated group), heroin (17% vs. 44%), or cocaine (3% vs. 11%). Pregnancies ended in 85 vs. 40 live births, one vs. two stillbirths, two vs. one spontaneous abortion, two vs. one voluntary termination, and one vs. one medical termination in the buprenorphine and the methadone groups, respectively. Newborns had a birth weight of 2,892 ± 506 g (buprenorphine) vs. 2,731 ± 634 g (methadone) and a body length of 47.6 ± 2.5 cm vs. 47.1 ± 3 cm. 18.8% vs. 10% of newborns were delivered before 37 weeks of amenorrhea. Neonatal withdrawal syndrome occurred more frequently in the methadone group (62.5% vs. 41.2, p = 0.03). After adjustment for heroin exposure in late pregnancy, rates of neonatal withdrawal were no longer different between the methadone and buprenorphine groups. Twenty-one babies (84%) in the methadone group and 20 (57%) in the buprenorphine group (p = 0.03) required opiate treatment.. We did not observe more frequent malformations or cases of withdrawal syndrome in the buprenorphine group than in the methadone-treated group. Buprenorphine appears to be as safe as the currently approved substitute methadone considered to date as the reference treatment for pregnant opioid-dependent women.

Topics: Adult; Analgesics, Opioid; Birth Weight; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies

The aim of the study was to evaluate the effect of substitution therapy in heroin addicted pregnant women on the course of pregnancy, perinatal outcomes and course of the neonatal abstinence syndrome.. A five-year randomised prospective comparative study. The study was carried out in the period of 2002-2007. The group of patients included 147 i.v. heroin-addicted pregnant women. All of them were outpatients of our Perinatal Care Unit. Their daily dose of heroin was approximately lg. Later, 30 women were disqualified from the study for breaking the randomised criteria engagement. The substitution therapy in women who agreed to undergo it, started during the I. trimester of pregnancy. Finally, 47 heroin, 32 methadone and 38 buprenorphine addicted women were enrolled in the study. Birthweight of newborns was compared with the national birthweight tables. Severity and duration of neonatal abstinence syndrome (NAS) were evaluated by Finnegan s score scale.. None of the women delivered before the end of 34th gestational week. We did not encounter any perinatal death or developmental defect. The lowest birthweight, the highest number of newborns with IUGR and the most numerous placental changes were found in the group of heroin-addicted women. The differences compared to the two groups receiving substitution therapy were statistically significant (p < 0.05). The severity and course of NAS were the most severe (p < 0.001) in newborns of women from the methadone group.. Comparison of the groups of outpatients is in many ways questionable because of the restricted possibility of the patients' control. The lifestyle of addicted women has the same impact as the drug use alone. This is probably the main reason for differences in some of the monitored parameters between individual groups. Based on our results we can state that substitution therapy provides pregnant women with the possibility of social stabilization and adequate prenatal care. substitution therapy decreases the street heroin consumption. Methadone notably protracts the newborn's abstinence syndrome. With regard to this fact, attention has been recently focused on substitution with buprenorphine that seems to be from this viewpoint a more considerate option.

Topics: Adult; Birth Weight; Buprenorphine; Female; Fetal Growth Retardation; Heroin; Heroin Dependence; Humans; Infant, Newborn; Life Style; Methadone; Narcotics; Neonatal Abstinence Syndrome; Outpatients; Postpartum Period; Pregnancy; Pregnancy Outcome; Prospective Studies; Severity of Illness Index

The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country.. Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group.. During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers.. Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Topics: Adult; Apgar Score; Birth Weight; Croatia; Female; Heroin; Heroin Dependence; Humans; Incidence; Infant Mortality; Infant, Newborn; Maternal Exposure; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pregnancy Outcome

In the present investigation we were interested to study the possible role of in-utero exposure to heroin and of the home environmental in the etiology of long-term developmental problems in children born to heroin-dependent parents in comparison to matched controls. The children were examined at .5-6 years of age by a developmental pediatrician and a developmental psychologist using, for the children up to 2.5 years of age, the Bayley Developmental Scales, and for children aged 3-6 years the McCarthy Scales for Children's Abilities. We examined 83 children born to heroin-dependent mothers, and compared the results to those of 76 children born to heroin-dependent fathers and to three control groups; 50 children with environmental deprivation, 50 normal children from families of moderate or high socioeconomic class, without environmental deprivation, and 80 healthy children from kindergartens in Jerusalem. There were five children (6.0%) with significant neurological damage among the children born to heroin-dependent mothers and six (7.9%) children among those born to heroin-dependent fathers. The children born to heroin-dependent mothers had a lower birth weight and a lower head circumference at examination when compared to controls. The children born to heroin-dependent parents also had a high incidence of hyperactivity, inattention, and behavioral problems. The lowest DQ or IQ among the children with cognitive levels above 70 was found in the children with environmental deprivation, next was the DQ or IQ of children born to heroin-dependent fathers, then the DQ or IQ of the children born to heroin-dependent mothers. When the children born to heroin-dependent mothers were divided to those that were adopted at a very young age and to those raised at home, the adopted children were found to function similarly to the controls while those not adopted functioned significantly lower. Our results show that the developmental delay and behavioral disorders observed among children born to drug-dependent parents raised at home may primarily result from severe environmental deprivation and the fact that one or both parents are addicted. The specific role of the in-utero heroin exposure in the determination of the developmental outcome of these children (if they do not have significant neurological damage), seems to be less important in comparison to the home environment.

Topics: Abnormalities, Drug-Induced; Birth Weight; Case-Control Studies; Child; Child of Impaired Parents; Child, Preschool; Developmental Disabilities; Family Health; Fathers; Female; Growth; Heroin; Heroin Dependence; Humans; Infant; Infant, Newborn; Israel; Male; Mothers; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Psychosocial Deprivation; Sex Ratio; Social Class

1. The pharmacokinetics of morphine were studied in 26 newborn premature neonates (26-38 weeks gestational age) who were given a loading dose of 50 micrograms kg-1 of diamorphine followed by an intravenous infusion of 15 micrograms kg-1 h-1 of diamorphine. Plasma concentrations of morphine were measured during the infusion at steady-state and for 24 h after the cessation of the diamorphine infusion. 2. The mean steady-state plasma morphine concentration (+/- s.d.) for a diamorphine infusion rate of 15 micrograms kg-1 h-1 was 62.5 +/- 22.8 ng ml-1. 3. Morphine clearance was 3.6 +/- 0.9 ml min-1 kg-1, the elimination half-life was 8.9 +/- 3.3 h and the volume of distribution was 2.7 +/- 1.01 kg-1. 4. Morphine elimination kinetics were described by a mono-exponential function. 5. There was a direct relationship between the gestational age of the patients and the clearance (r2 = 0.31, P = 0.003) and half-life (r2 = 0.35, P = 0.01) of morphine, but no relationship was found between gestational age and volume of distribution. 6. The results suggest that the currently used dosing regimen of diamorphine achieves a safe and effective morphine concentration in the premature newborn but that the loading dose could be modified to achieve a more rapid onset of analgesia.

Topics: Birth Weight; Chromatography, High Pressure Liquid; Gestational Age; Half-Life; Heroin; Humans; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Metabolic Clearance Rate; Morphine; Radioimmunoassay

Maternal, perinatal and neonatal factors of 27 newborns of heroin addicted mothers were reviewed between 1980 and 1984. Results were compared with a control group of 2,587 normal newborns. A progressive increase in number of cases was observed in the last years. Mean age of heroin-addicted mothers was significant lower than control group (p less than 0.001). Only 18.5% were under obstetrical control for at least 4 times (p less than 0.001) and 40.7% had antecedents previous abortions (p less than 0.025). Four cases of maternal syphilis were diagnosed and also four mother were positive to HBsAg; statistical difference in both cases was highly significant with respect to control group (p less than 0.001). A higher index of premature rupture of membranes (11.1%, p less than 0.001) and cesarean sections (25.9%, p less than 0.001) was appreciated. No significant difference was observed attending to fetal presentation, instrumental delivery, Apgar test scores and pH of umbilical artery (p greater than 0.05). A higher incidence of preterm (18.5%, p less than 0.01) and small for gestational age babies (44.4%, p less than 0.001) was ascertained. Pregnancy control and no smoking habit might influence birth weight (p less than 0.001). Neonatal withdrawal syndrome was present in 44.4% and was related to mother's last dose and secondary to degree of heroin abuse (p less than 0.025).

Topics: Birth Weight; Female; Gestational Age; Hepatitis B; Heroin; Heroin Dependence; Humans; Infant, Newborn; Male; Maternal Age; Pregnancy; Pregnancy Complications; Prenatal Care; Substance Withdrawal Syndrome; Syphilis Serodiagnosis

On the basis of current literature and their own experience, the authors discuss (1) the major complications possible in pregnant drug addicts, (2) whether the complications can be attributed to deficient prenatal care or to effects of drug abuse, and (3) the best prenatal care of drug-addicted mothers.

Topics: Birth Weight; Delivery, Obstetric; Female; Fetal Monitoring; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Infant Mortality; Infant, Newborn; Methadone; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prenatal Care; Substance Withdrawal Syndrome

Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.

Topics: Birth Weight; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Methadone; Nervous System Diseases; Pregnancy; Sleep; Substance-Related Disorders

The behavioral of 21-day old rats whose mothers were administered heroin (5 mg/kg daily) throughout gestation and lactation was studied utilizing an activity wheel, activity cage, open field test, and step-down latency times from an elevated platform. The total score of all behavioral tasks of offspring from heroin-injected females was statistically different from that of pups from saline-injected mothers, with heroin-treated animals appearing more active.

Topics: Animals; Birth Weight; Female; Heroin; Maternal-Fetal Exchange; Motor Activity; Pregnancy; Rats; Time Factors

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken. Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2.961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.

Topics: Adult; Birth Weight; Dose-Response Relationship, Drug; Ethnicity; Female; Gestational Age; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Small for Gestational Age; Maternal Age; Maternal-Fetal Exchange; Methadone; Pregnancy; Pregnancy Complications; Prenatal Care

Topics: Apgar Score; Birth Weight; Breech Presentation; Chlorpromazine; Delivery, Obstetric; Female; Fetal Death; Hepatitis; Hernia, Inguinal; Heroin; Heroin Dependence; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Jaundice, Neonatal; Menstruation Disturbances; Pregnancy; Pregnancy Complications; Prenatal Care; Substance Withdrawal Syndrome; United States

Topics: Adult; Birth Weight; Black or African American; Ethnicity; Female; Heroin; Heroin Dependence; Humans; Illegitimacy; Infant, Newborn; Maternal Age; New York City; Pregnancy; Pregnancy Complications; Puerto Rico; Substance-Related Disorders

Topics: Abnormalities, Drug-Induced; Adult; Birth Weight; Female; Fetal Death; Fetus; Gestational Age; Heroin; Humans; Infant Mortality; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adrenal Cortex Hormones; Birth Weight; Blood; Delivery, Obstetric; Female; Fetus; Gestational Age; Heroin; Heroin Dependence; Humans; Infant, Newborn; Labor, Obstetric; Methadone; Pregnancy; Substance-Related Disorders; Time Factors; Twins; Umbilical Cord

Topics: Administration, Oral; Adult; Apgar Score; Birth Weight; Female; Fetal Death; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Methadone; New York City; Obstetric Labor, Premature; Parity; Pregnancy; Pregnancy Complications; Prognosis; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Birth Weight; Depression; Female; Fetal Diseases; Fetus; Heroin; Heroin Dependence; Humans; Hyperbilirubinemia; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Microsomes, Liver; Narcotics; Pregnancy; Respiratory Distress Syndrome, Newborn; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adrenocorticotropic Hormone; Adult; Age Factors; Birth Weight; Dexamethasone; Estriol; Female; Heroin; Humans; Infant, Newborn; Methadone; Metyrapone; Parity; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Amniocentesis; Bilirubin; Birth Weight; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Methadone; Pregnancy; Pregnancy Complications; Prenatal Care; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Acetylcholine; Birth Weight; Central Nervous System; Epinephrine; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Infant, Premature, Diseases; Nicotine; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders; Sweat Glands; Sweating

Topics: Birth Weight; Child Development; Child Welfare; Chlorpromazine; Heroin; Heroin Dependence; Humans; Infant, Newborn; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Acute Disease; Birth Weight; Carbon Dioxide; Enzyme Induction; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Obstetric Labor, Premature; Partial Pressure; Pregnancy; Respiratory Distress Syndrome, Newborn; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Adolescent; Adult; Apgar Score; Birth Weight; Female; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Methadone; Neurologic Manifestations; Opium; Phenobarbital; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders; Vomiting

Topics: Adolescent; Adult; Age Factors; Anemia; Birth Weight; Heroin; Humans

Topics: Birth Weight; Chlorpromazine; Congenital Abnormalities; Female; Heroin; Humans; Infant, Newborn; Jaundice, Neonatal; Magnesium; Male; Maternal-Fetal Exchange; Morphine; Pregnancy; Quinine; Sleep; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Adolescent; Adult; Birth Weight; Female; Heroin; Humans; Infant, Newborn; Labor Presentation; Methadone; Pregnancy; Pregnancy Complications; Substance-Related Disorders; Syphilis