Dr. Craig Towers' pregnant patients who were addicted to opioids frequently asked him whether he could help them get off drugs so their babies wouldn't suffer agonizing withdrawal symptoms after birth. Towers and his group, High Risk Obstetrical Consultants in Knoxville, Tenn., see 300 to 400 opiate-addicted pregnant women a year.
Like most doctors across the country, Towers would tell them no, because detox would risk premature labor or even fetal death. Instead, he would recommend that they receive drug maintenance therapy with methodone or buprenorphine through their pregnancy.
That's the long-standing opinion of the American College of Obstetricians and Gynecologists, even though it means newborns are likely to suffer neonatal abstinence syndrome, or NAS, and have to be hospitalized and slowly weaned off the opioid drug.
But, challenged by his patients, Towers dug into the research literature and found studies suggesting that detoxification during pregnancy is not harmful. So he and his colleagues launched a five-year observational study of 301 opiate-addicted pregnant women who underwent four detox methods. The results were published recently in the American Journal of Obstetrics and Gynecology.
They found no adverse fetal outcomes related to detoxification. In addition, among women who went through detox with accompanying intensive behavioral therapy, only about 17% of their newborns suffered NAS, primarily because the mother had relapsed.
The findings may prompt more physicians to break with standard clinical practice and offer detox therapy during pregnancy, which could sharply reduce the number of babies with NAS.
“I'm not saying, 'Change what you're doing and start detoxing everyone immediately,' ” said Towers, a professor of obstetrics and gynecology at the University of Tennessee Medical Center. “But for 40 years we've not been doing that because we thought it was harmful. We've now shown that's not true. This is doable, but we have to set up behavioral programs because otherwise the relapse rate is too high.”