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Practice Pregnancy Plus

Pregnancy and injecting drug use

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1303
  1. James Bell, consultant in addictions12,
  2. Lucy Harvey-Dodds, fellow in addiction medicine2
  1. 1National Addiction Centre, Institute of Psychiatry, London SE5 8RS
  2. 2The Langton Centre, Sydney, NSW 2011, Australia
  1. Correspondence to: J Bell james.bell{at}

Injecting drug use has adverse effects on pregnancy and perinatal outcomes. Methadone treatment improves birth rate but carries a risk of neonatal abstinence syndrome; withdrawal of methadone during pregnancy is not recommended

The case described in the Scenario box highlights some of the problems of managing a pregnant injecting drug user. Such patients often present late and have chaotic lifestyles, including poor care for themselves and compromised capacity to care for infants and children.


A 23 year old woman presented, stating she was pregnant and requesting methadone treatment. She reported having used heroin since the age of 13. She had been on buprenorphine for six months but had dropped out two months earlier. She was started on methadone and confirmed to be 20 weeks pregnant. In addition to heroin, she reported smoking cigarettes and cannabis.

She lived with her partner of five months, who was also on methadone. Medically, she had asthma and was hepatitis C positive. She rarely accessed health care. This was her second pregnancy. Her first child had been born one year earlier. During that pregnancy she was homeless and using heroin regularly. Her daughter was born at 36 weeks and weighed 2800 g. The child was removed at birth and remains in care.

Treatment comprised daily supervised methadone, weekly review by a nurse and medical practitioner, drug testing of urine, and assistance to attend antenatal care. Her methadone dose was increased to 50 mg/day by the time of delivery. Urine tests showed only methadone.

A baby weighing 3100 g was delivered at full term and did not need treatment for neonatal abstinence syndrome. After discharge, mother and baby continued to receive support and supervision from multiple services.

How common is injecting drug use in pregnancy?

Accurate figures on numbers of pregnant women who misuse drugs are difficult to obtain. Health professionals do not always …

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