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Opiate use, pregnancy and reproductive health
Mary Hepburn, Honorary Consultant Obstetrician and Gynaecologist, Princess Royal Maternity Hospital, Glasgow
Abstract
The most common illicitly used opiate is heroin. Heroin can cause women’s periods to stop and can cause infertility but not necessarily together. Women using heroin can therefore still become pregnant even if they are not menstruating and should use effective contraception if they do not want to become pregnant. Poor nutrition, common among people using heroin can have similar effects. Methadone does not have these effects so women prescribed methadone or given any treatment that improves their health and nutrition will become more fertile making reliable contraception even more important. Heroin is short acting so its use is associated with recurrent minor degrees of withdrawal. This causes muscle spasm in different parts of the body resulting in a number of symptoms including diarrhoea and muscle cramps. During pregnancy its use can cause miscarriage and premature delivery and can restrict growth of the baby. Methadone does not cause these effects so during pregnancy it is important that women using heroin are prescribed methadone as a substitute. Other commonly used opiates / opioids such as dihydrocodeine are similarly harmful to the unborn baby so again treatment with methadone is safer. However methadone can cause withdrawal symptoms in the baby but while these are distressing for the mother and baby they can be treated and do not have long lasting ill effects. Other drugs are now prescribed as substitutes for heroin but there is less information about their use in pregnancy. Buprenorphine seems similar to methadone and also causes withdrawals in the baby that appear to be at least as severe as those due to methadone. There is therefore no indication to switch from one to the other during pregnancy. While it is safe to withdraw from opiates at any speed and at any stage of pregnancy stability is more important than abstinence and polydrug use is associated with more severe withdrawals in the baby. Breast feeding reduces the severity of withdrawals and has a number of benefits for the baby so all women using drugs should be encouraged to breast feed provided they are not HIV+ve.
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Biography
Mary Hepburn BSc MD MRCGP FRCOG
Senior lecturer in women’s health / Consultant obstetrician and gynaecologist
Mary Hepburn trained first as a general practitioner and then as an obstetrician and gynaecologist. Her main interest is in the effects of poverty on health and access to healthcare services. She established and is consultant in charge of the Glasgow Women’s Reproductive Health Service for women with social problems. Reasons for attendance include problem drug and /or alcohol use, blood borne virus infection, mental illness, learning difficulties, a history of statutory care for mother and / or other children, violence or homelessness. The service also cares for asylum seeking and refugee women with special needs. Dr Hepburn has also worked in the UK and in developing and /or resource poor countries with WHO and various NGOs.
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