Medication Assisted Treatment In Pregnancy And Neonatal Anthropometrics

INTRODUCTION: Opiate use is an epidemic, and, increasingly, pregnant women are managed with medication assisted treatment (MAT), typically Subutex (SUB) or methadone (MET). MET has been associated with decreased birth length (BL) and head circumference (HC) versus SUB in a small study, but without comparison to normal controls. Decreases in HC at birth are correlated with adverse neurodevelopment later in life. Shorter BL as seen with in utero malnutrition, is associated with hypertension and obesity in adulthood. We hypothesized that MAT treatment with MET negatively affects HC and BL. METHODS: A retrospective cohort study evaluating neonatal HC and BL was completed with mothers receiving MAT (SUB or MET), and compared to neonates whose mothers were not exposed to opioids (non-MAT). Only neonates born term (>37 weeks) to Caucasian women who smoked were included. HC and BL were converted into z-scores utilizing World Health Organization's growth charts. P <.05 by non-parametric Kruskal-Wallis ANOVA with Dunn's multiple comparison test was considered statistically significant. RESULTS: Mean birthweights were 3,163 g in non-MAT, 2,749 g in SUB and 2,846 g in MET groups ( P =.0008). Mean HC (±SEM) z-scores were −0.08 (±0.09, n=130) in non-MAT, −0.13 (±0.11, n=80) in SUB and −0.47 (±0.09, n=166) in MET groups. Mean BL z-scores were −0.35 (±0.09, n=135) in non-MAT group, −0.06 (±0.13, n=90) in SUB group and −0.57 (±0.11, n=163) in MET groups. MET treatment lead to significantly smaller HC and BL. CONCLUSION: MAT with MET is associated with smaller neonatal HC and BL. While neonates exposed to SUB showed smaller HC but not impaired BL when compared to non-MAT. Long term neurodevelopment issues and adult onset chronic diseases associated with decreased HC and BL may be a reason for recommending SUB for MAT since only HC was decreased. When starting MAT, counseling should include not only short term risks, but also the potential lifelong risks, for the neonate.