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Pregnancy in an opiate-dependent patient:
preventing complications

Monitoring a patient dependent on opiates (heroin, etc.) during her pregnancy requires cross-disciplinary collaboration. Heroin replacement therapy (methadone or buprenorphine) improves the prognosis for both mother and child.

A pregnant woman dependent on opiates (heroin, etc.) poses a complex problem, with both the mother and child at risk, in a difficult social and psychological context. According to available data, sudden withdrawal from opiates carries the risk of foetal suffering at the end of the pregnancy.

Heroin replacement therapy, as part of a multidisciplinary approach including psychological and social support, leads to improved ante-natal monitoring, fewer maternal complications, and lower neonatal morbidity and mortality, with no demonstrated risk of malformation. In the absence of prior replacement therapy, methadone is the best option. However, if the patient is already successfully being prescribed buprenorphine replacement therapy, there is no convincing justification for replacing this with methadone.

In all cases (replacement therapy or not), withdrawal syndrome is frequent in the newborn, and this should be anticipated and treated appropriately. Replacement therapy is compatible with breastfeeding a healthy infant.

©Prescrire December 2005

Source: "Grossesse chez les patientes dépendantes aux opiacés : un traitement substitutif améliore le pronostic" Rev Prescrire 2005 ; 25 (267) : 836-841.

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