There are several health problems during pregnancy that should be discussed including:
Advice should be given regarding potential complications of pregnancy associated with drug use:
Opioid Detoxification in pregnant women:
Suboxone is currently contraindicated in pregnant women and nursing mothers. Transition to alternative treatment, eg methadone should therefore be considered for women who are actively planning a pregnancy.
Partial splitting of the dose may also be considered for stable pregnant patients in the latter half of pregnancy in order to avoid the necessity for increase in the dose, especially for those on doses below 60mg. A single daily dose should be reinstituted following delivery.
A small number of women become fast metabolizers of methadone or suboxone in pregnancy. Where this is suspected, obtain trough and peak serum levels and discuss with the BOPAS before instituting split dosing. These women are at greater risk of destabilization in pregnancy and timely assessment and management can prevent this.
In general, it is safe to breastfeed while a mother is taking methadone as long as there are no other factors that would make breastfeeding unsafe, such as using illegal drugs or using certain prescription medications. Methadone is found in breast milk, but only a small amount gets passed along to the baby.
There are many benefits to breastfeeding for both the mother and her baby.
Although there is no official statement saying that mothers cannot breastfeed if they are taking a certain amount of methadone, it would be wise to discuss this with the specialist service to learn more about it.
*See Section 6.7 Management of Pregnant and Breastfeeding Women page 52-56 of " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"
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