High-dose methadone maintenance in pregnancy: maternal and neonatal outcomes.

OBJECTIVE: This study assesses the effect of higher doses of methadone during pregnancy on maternal and fetal outcomes.

STUDY DESIGN: We retrospectively reviewed clinical data for 81 mothers who received methadone and their 81 offspring. The cohort was divided into high-dose (>/=100 mg) and low-dose (<100 mg) groups.

RESULTS: There were no differences in the rate of medication treatment for neonatal abstinence symptoms or days of infant hospitalization between the high-dose (mean, 132 mg) and low-dose (mean, 62 mg) groups. Despite longer histories of opiate abuse, the high-dose group had less illicit drug use at delivery. The whole cohort, which received an average of 101 mg/d, had an 81% rate of negative toxicology screens at delivery.

CONCLUSION: High doses of methadone were not associated with increased risks of neonatal abstinence symptoms but had a positive effect on maternal drug abuse. Arbitrarily limiting methadone dose as a way of minimizing the risks of neonatal abstinence symptoms may be unwarranted.