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PRACTICE: James Bell and Lucy Harvey-Dodds Pregnancy and injecting drug use BMJ 2008; 336: 1303-1305 [Full text]

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Postnatal outcome in infants exposed to methadone in utero

Laura McGlone, Helen Mactier, Jane R MacKinnon   (15 September 2008)

Postnatal outcome in infants exposed to methadone in utero 15 September 2008
Laura McGlone, Paediatric Registrar Princess Royal Maternity, Alexandra parade, Glasgow, G31 2ER, Helen Mactier, Jane R MacKinnon Send response to journal: Re: Postnatal outcome in infants exposed to methadone in utero	We wish to respond to Bell and Harvey-Dodds comments regarding the safety of methadone in pregnancy, specifically with regard to postnatal development. There are increasing concerns regarding the incidence of nystagmus and delayed visual development in infants born to drug-misusing mothers (1, 2) and our own data have shown alteration in visual evoked potentials in newborn infants exposed to methadone in utero compared to controls (2). A recently published Australian study has demonstrated adverse neurodevelopmental outcome in a cohort of 133 singleton infants delivered to compliant methadone-prescribed women (3). These infants were found to have significant delay at 18 months and 3 years on various different scales of infant development. In the same paper, the authors undertook a literature review of neurodevelopmental outcome which confirmed that infants exposed to opiates in utero are at significant risk of psychomotor developmental delay, low IQ and behavioural problems (3). The majority of women use illicit substances in addition to methadone (1-3) and whether the visual and developmental problems noted in these infants are attributable to illicit substances, prescribed maternal methadone, pharmacological treatment of NAS or other medical or social issues is not yet clear. It must also be noted that significant health care resources are required for the care of these infants – in our unit, over a three year period 478 infants born to drug-misusing mothers represented 3% of births and utilised 18% of neonatal unit cot days. Difficulties in separating the effects of drug-exposure and environment on postnatal outcome in infants born to drug-misusing mothers should not detract from the need for follow-up, support and further research in these highly vulnerable infants. Dr Laura McGlone, Paediatric Registrar, Princess Royal Maternity, Alexandra Parade, Glasgow. Dr Helen Mactier, Consultant Neonatologist, Princess Royal Maternity, Alexandra Parade, Glasgow. Dr Jane R MacKinnon, Consultant Paediatric Ophthalmologist, Royal Hospital for Sick Children, Dalnair Street, Glasgow. 1. Mulvihill AO, Cackett PD, George ND, Fleck BW. Nystagmus secondary to drug exposure in utero. British Journal of Ophthalmology 2007; 91: 613- 5. 2. McGlone L, Mactier H, Hamilton R, Bradnam M, Boulton R, Borland W, Hepburn M, McCulloch DL. Visual evoked potentials in infants exposed to methadone in utero. Archives of Disease in Childhood 2008; 93: 784-6. 3. Hunt RW, Tzioumi D, Collins E, Jeffery H. Adverse neurodevelopmental outcome of infants exposed to opiate in utero. Early Human Development 2008; 84: 29-35. Competing interests: All authors declare that the answer to the questions on your competing interest form - http://resources.bmj.com/bmj/authors/checklists-forms/competing-interests - are all No and therefore have nothing to declare. Competing interests: None declared