Opioids and development: New lessons from old problems

Placed within the context of the average number of births in the U.S. every year (roughly 3.3 million), one can calculate that at least 1 in 1,000 births is by a mother using heroin or methadone. Even before birth the offspring of opioid-dependent women are subjected to a host of potential problems. During the course of pregnancy, the mothers of these children often encounter medical complications, including infectious diseases, nutritional deficits, and an abnormal incidence of veneral disease. Obstetrical complications include toxemia of pregnancy and intrauterine growth retardation. Additionally, spontaneous miscarriage, abortion, and stillbirths have been suspected of being higher than normal among opioid-dependent women (Salerno 1977). Many of these coassociated medical and obstetrical complications appear to be secondary to the lifestyle and habits of the pregnant addict (Perlmutter 1974), with prenatal care often being neglected. The very fact that enrollment in the methadone program places women in touch with health professionals who encourage prenatal care has been an extremely positive feature of this program.