AT THE PREGNANCY MEETING

ATLANTA (FRONTLINE MEDICAL NEWS) – Contrary to conventional wisdom and standard obstetrical practice, opiate-addicted women can safely undergo detoxification during pregnancy, findings in more than 300 women suggest.

Over a 5-year period, 301 women with opiate addiction were detoxed during pregnancy with no adverse fetal outcomes related to the detox identified, Dr. Jennifer Bell reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.

Of the women studied, 108 were acutely detoxed while incarcerated, 100 went through inpatient detox, and 93 went through slow outpatient Subutex detox over 6-12 weeks. Relapse rates in those groups were 19%, 71%, and 15%, respectively.

However, among 23 women in the inpatient detox group who had close outpatient follow-up management, the relapse rate was 17% versus the 71% overall relapse rate with inpatient detox, said Dr. Bell , a third-year resident at the University of Tennessee Medical Center, Knoxville.

No cases of intrauterine fetal demise (IUFD) occurred during the course of the study, and the rate of preterm delivery did not differ between detox groups, Dr. Bell noted.

The rate of preterm delivery was 17% overall (51 patients), but 28 of the patients were induced for suspected intrauterine growth restriction. Only 16 had the condition.

Detox was slightly more expensive than drug maintenance in this study, but was cost saving when considered against the cost of treating one newborn with neonatal abstinence syndrome – $63,000 on average nationally.

Standard practice is to not detoxify opiate-addicted pregnant women, based primarily on two case reports from the 1970s that suggested fetal harm from detox. However, in the current study and five other studies published since that time, a total of 684 patients have been detoxed with no cases of IUFD, suggesting that detox is not harmful during pregnancy. And though relapse rates are high, this is typically among women who do not have continual follow-up management, according to Dr. Bell.

Once a patient is drug free, intense patient behavioral health follow-up is needed for success, Dr. Craig V. Towers , the lead author on the study, said in an interview. Such follow-up is costly, but not nearly as costly as caring for infants with neonatal abstinence syndrome, he said.

In Tennessee alone, where approximately 1,000 cases of neonatal abstinence syndrome occur each year, a 50% reduction in these cases could save more than $30 million per year, said Dr. Towers, also of the University of Tennessee Medical Center.

The framework for follow-up management programs for women who undergo detox could be paid for with a portion of those savings, said Dr. Towers, who is currently working with the state health department on developing a plan for such an approach to the problems of opiate addiction in pregnancy.

The current findings represent the first step toward an improved system, as many women who become pregnant while addicted to opiate drugs desire to detox, but aren’t given the option, he said. “We need to get rid of this argument that [detox] is harmful to the baby.”

The researchers reported having no financial disclosures.

sworcester@frontlinemedcom.com

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