Hi
I was challenged this week to provide the evidence for the risk of fetal distress and stillbirth due to dose reduction during the 3rd trimester of pregnancy (as commonly quoted, including in the orange book): any idea what evidence is used for this?


Cheers,
Martyn

http://www.exchangesupplies.or.../mary_hepburn_2.html

Does this help at all? Mary I understand does not mind people mailing her for help.A very lovely lady and extremely knowledgeable.

Hi Martyn, Mary Hepburn as Simon has highlighted is well versed in this area and advises stability. everyone agrees on stability but my understanding is that reducing, and speed of reducing in 1st and 3rd trimester is contentious. obviously there's no RCTs to confirm all this so we're reliant on case reports which is where some take a slightly different emphasis. Jan Palmer is someone else who has done a lot of work around this. she's contactable through DH offender health

Agree re Mary and can I point you to the pregnancy section in the methadone guidance (written by Mary and others). We tried to get her work into the clinical guidelines but I feel this section in CG is outdated and not helpful. But they do have some world evidence on their side which in summary says the worse thing for the baby is relapse close to birth cause if woman feels bad the baby feels far worse. In many countries including (as far as I know - not checked since 2008) US, Ireland, Australia woman are forced to stay on methadone maintenance and have their dose increased to prevent this happening. I was accused of all manner of things by an Australian colleague when I suggested it was woman's choice - he felt 'they' should be forced to stay on MM!

Hi Martyn,

The following article might help.

Winklbaur B., Kopf N., Ebner N. et al. Request reprint
Addiction: 2008, 103, p. 1429–1440.

Or see Daily Dose of 19.9.09 for a summary of it.

Best wishes,

George