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Background: Although methadone maintenance is the standard treatment of opiate addiction in pregnancy, opinion as to its utility is divided. The aim of this study was to analyze polydrug abuse, pregnancy outcome and fetomaternal complications among pregnant women in a major Swiss methadone maintenance program., Methods: Prospective data collection of all pregnant opiate addicts and their neonates from 1996 to 2001., Results: Maternal complications occurred in 73% and fetal complications in 34% of the pregnancies. The average methadone dose at delivery in the 89 pregnancies was 40.9 +/- 32.7 (0-150) mg/day. Sixty-four percent of the women were co-users of cocaine and/or heroin. Birthweight was lower in polydrug abusers than in near-exclusive methadone users (p = 0.001)., Conclusion: The high rate of maternal complications demonstrates the need for further improvement in antenatal management of opiate addiction in pregnancy. Methadone maintenance is inefficient in preventing pregnancy exposure to additional illicit drug consumption. Additional illicit heroin and/or cocaine abuse does not seem to increase the incidence of fetomaternal complications during pregnancy, but reverses the positive impact of methadone on birthweight. Heroin-assisted treatment may be a more effective method of minimizing the use of street drugs.

Background: The aim of the study was to analyze the neonatal impact of a methadone maintenance program in pregnancy, and the social resources of the families involved., Methods: Descriptive analysis of neonatal data in live births after 24 weeks of gestation in pregnant women enrolled in a methadone maintenance program. The data of 86 babies were analyzed., Results: Median gestational age was 38 (0)/(7) (31-41) weeks; 21 babies (24%) were premature. Median birthweight was 2662 (1340-4050) g; 27% of babies were growth retarded (<3rd centile), and 13% had microcephaly (<3rd centile). Sixty-two percent developed abstinence syndrome requiring pharmacological treatment for a median 47 days. Child Protective Services (CPS) were involved in 56% of cases, and 42% of newborns required placement outside the mother's home., Conclusions: Babies born to women on methadone had a fourfold higher incidence of prematurity, a ninefold higher incidence of intrauterine growth retardation (IUGR), and a fourfold higher incidence of microcephaly compared with the normal population. Sixty-two percent required pharmacological treatment for abstinence syndrome and 42% required placement.

Aims: Optimal prenatal management of twin pregnancies requires diligent sonographical evaluation. In Switzerland the efficiency of routine ultrasound during pregnancy has recently become a point of debate. Aim of this study was to evaluate the quality of routine ultrasound of twin pregnancies in Kanton Aargau., Method: Standardised prospective postal interview of each practitioner caring for twin pregnancies during the time period of August 1st, 1998 to July 30th, 1999 in Kanton of Aargau. We chose the Aargau Kanton as being representative of the Swiss population in general on the basis of its average demographic and geographical condition. In addition, evaluating an entire Kanton allows the comparison of data with the official data of the Federal Statistical Office., Results: 81 twin pregnancy cases were delivered during this time period. 65 interviews could be analysed which provided full information. The first sonographic diagnosis of twin pregnancy was confirmed at a mean of 11 (5 - 32) weeks gestation. All twin pregnancies were diagnosed before the onset of labour. 2/65 of the twin pregnancies remained undiagnosed until the 3rd trimester. In one of these cases the patient had refused an ultrasound examination. In 57/65 cases clear information about amnionicity, but in only 53/65 cases additional information about chorionicity was gained., Conclusion: All twin pregnancies were detected sonographically before delivery. Determinations of amnionicity and chorionicity were possible in 87 % and 81 %, respectively, which could be improved.