Treatment of heroin addiction during pregnancy is particularly important. The street drug can produce wide swings in blood levels, from intoxication to withdrawal, that can lead to premature labor, spontaneous abortion and other severe adverse effects. In addition, heroin is often contaminated with teratogenic substances.[27] The indicated treatment for heroin addiction during pregnancy is methadone maintenance, which produces a fairly constant and safe physiologic effect. Pregnancy increases methadone metabolism, and some patients require two doses per day to maintain stable blood levels as pregnancy progresses.

Infants born to mothers maintained with methadone may be physically dependent on opioids; however, they are not addicted and are easily treated in the nursery. Unmonitored intrauterine withdrawal is much more dangerous. While lower doses of methadone are less likely to cause withdrawal symptoms in the neonate, the most important dosing consideration is giving the patient an amount sufficient to prevent relapse to heroin, with all its associated risks to mother and fetus.

Prescribed methadone use is compatible with breast-feeding. However, maternal infection with HIV or human T-cell lymphotrophic virus I/II often precludes breast-feeding by women who have injected heroin.

http://www.nida.nih.gov

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