[Management of drug addict pregnant women and their children]

ENHANCING THE EFFECTIVENESS OF RESIDENTIAL TREATMENT FOR SUBSTANCE ABUSING PREGNANT AND PARENTING WOMEN: FOCUS ON MATERNAL REFLECTIVE FUNCTIONING AND MOTHER-CHILD RELATIONSHIP

Substance abuse during early motherhood has become a significant problem and has led to accelerated efforts to develop specific treatment facilities for these mothers and children. Despite the often intensive treatment efforts in residential settings, there is surprisingly little evidence of their efficacy for enhancing the quality of caregiving. The situation of these mother-child pairs is exceptionally complex and multilevel, and has to be taken into account in the content and structuring of treatment. Intensive work in the "here and now" focusing on the mother-child relationship from pregnancy onwards in an effort to enhance maternal reflective capacity and mindedness is considered a key element for better treatment prognosis, in terms of both abstinence and quality of parenting. Pioneering work with such a focus is described in this article.

Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution

Specialized prenatal care and substitution programs improve the perinatal prognoses of pregnant drug-abusers and their infants. Although methadone is well documented, little is known about high-dose buprenorphine (HDB). This prospective, multicenter (n = 35) observational study included 259 women on maintenance during pregnancy: 39% on methadone and 61% on HDB. Major findings were: 46% of them received good prenatal care; 62% had peridural analgesia; 12.3% delivered prematurely (<37 weeks); mean gestational age, 38.6 weeks; mean birth weight, 2822g. Three-quarters of the newborns developed neonatal abstinence syndrome (NAS) beginning at a mean age of 40h, with the mean maximum Lipsitz score of 9.1 at 72 h; half of them were treated, mainly with morphine hydrochloride. No baby died. Newborns were discharged with their mothers (96%) or placed in foster care (4%). Comparing methadone with HDB, respectively, mean age at the maximum Lipsitz score was 81 h versus 66 h (P = 0.066). The perinatal medical and social prognoses for these 259 drug addicts and their infants appeared to be improved by specialized prenatal care and was similar for methadone or BHD substitution during pregnancy.

[Perinatal drug abuse. Collaborative perinatal care for drug abusers and their infants]

Pregnant drug abusers are a group with very high risk of perinatal morbidity. Intensive prenatal care, with substitution maintenance programs, by a medico-psycho-social team working in concert with ambulatory health and social workers, may prevent perinatal complications and mother-infant separation. The results of such a perinatal program, in a suburban low-socioeconomic population, are described. In comparison with reports in the literature, this approach appears to provide significant perinatal medical and social prognosis for pregnant abusers and their neonates.

[Management of the opioid withdrawal in the neonates: French and European survey]

Maternal opioid abuse during pregnancy results in 60 to 95% of neonatal withdrawal. The literature review on the evaluation of the severity of the related symptoms and treatments used shows an absence of consensus.

MATERIALS AND METHODS

To survey the management of the neonatal withdrawal a questionnaire was sent to French and other European pharmacists.

RESULTS

Fifty-eight questionnaires were returned, 37 from France. In 74%, a written protocol about the management of the neonatal withdrawal was available. The severity of the symptoms was assessed using the Finnegan's scale in 55% of the cases and the treatment was a substitute opiate in 72.5%. In 64% of the cases, this drug was an oral morphine solution: a hydrochloride solution in France and a sulfate solution in other E.U countries at the most common dose of 0.5 to 1mg x kg(-1) x d(-1) and 0.24 mg x kg(-1) x d(-1) respectively.

DISCUSSION

The solution used in France is contra-indicated in infants less than six months and the presentation is not adapted to this use.

CONCLUSION

This morphine survey points out that a preparation intended for infants should be developed and licensed in this indication to improve the use of treatment.

[Buprenorphine and pregnancy. Analysis of 24 cases]

BACKGROUND

Maintenance therapy of drug-addict mothers with medical and psychosocial support may reduce complications (prematurity, growth retardation, fetal distress and fetal death). Methadone has been widely used during pregnancy with beneficial effects. Buprenorphine (BUP) is used more and more and shows the same beneficial effects.

PATIENTS AND METHOD

Twenty-four pregnant women received BUP and their infants were enrolled in the study. Thirteen retrospective (GI) and 11 prospective (GII) cases were studied. In the GII, the women were treated and followed up in an interdisciplinary manner.

RESULTS

Complications in GII were less frequent than in GI: 9 vs 30% of prematurity, 9 vs 46% of fetal growth retardation and 0 vs 23% of acute fetal distress. However, the frequency of withdrawal syndrome was the same in both groups, 63 vs 69%, though improvements came more rapidly in GII.

CONCLUSION

This study shows that the use of BUP during pregnancy, combined with medical and psychosocial support, may reduce addiction complications. This support has to be maintained after the birth.