Maternal Narcotic Addiction: Pregnancy Outcome in Patients Managed by a Specialized Drug‐Dependency Antenatal Clinic

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Abstract
EDITORIAL COMMENT: The obstetrician's concerns regarding maternal narcotic addiction in pregnancy are ft) difficulties in recognition (ii) results of management in pregnancy and (iii) the long-term results for mother and child — we leave to our politicians and police the problems of prevention of drug trafficking and the socioeconomic ills on which the trade flourishes! This paper reports a relatively large experience, confirming that pregnancy results are satisfactory, although there are increased incidences of prematurity and fetal growth retardation. The problems of diagnosis and long-term follow-up remain. The cost-effectiveness of the numerous available antenatal screening tests is an important consideration, since together with clinical findings they provide the basis of antenatal care. Should urinary drug screening be added to the list below, which is considered by the editor to be appropriate for Australasia? Can we believe paediatric claims that babies of unrecognized addicts never escape detection after birth because of their withdrawal symptoms? The authors of this paper on questioning have stated that ‘not all babies born to our patients went through a classical withdrawal and there are certainly some who would escape detection unless a formalized abstinence scoring chart is used’ Another problem that has tested at least I Australian ethics subcommittee is whether or not urinary drug screening in pregnancy is ethical without the informed consent of the patient! Summary: A retrospective analysis has been made of the outcome of pregnancy in 174 women abusing narcotics, managed by a specialist team from a drug-dependency antenatal clinic. These women were cared for through 182 pregnancies of greater than 20 weeks' gestation, resulting in 183 live and 5 stillbirths. The majority of patients were enrolled in a methadone programme and stabilized on the drug before the third trimester. The group was characterized by a high prevalence of previous obstetric and medical problems. The most common antenatal complications were preterm labour (24%) and anaemia (12%). Preterm delivery and small-for-gestational-age each occurred in a quarter of pregnancies. The mean birth-weight for the group was 2.746g ± 721g; mean ± S.D. Eight perinatal deaths occurred (5 stillbirths, 3 neonatal deaths). giving a perinatal mortality rate of 43/1,000. The data on narcotic abusers have been compared with similar data obtained from randomly selected public antenatal clinic patients who delivered during the same period.