Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta-analysis.
Victoria J Monnelly, Ruth Hamilton, Francesca M Chappell and 2 others
PMID 30511742WHAT IT FOUND
At 6 months, mental and motor score differences were small and uncertain.
By age 2, exposed children scored lower on those tests, and some had abnormal visual tests. This cannot prove methadone caused it; other drug exposure and other differences were common.
Key findings
01At 6 months, the pooled mental and motor score differences were small and could have included no difference.
02At 2 years, children exposed to methadone before birth had lower mental and motor scores in the pooled Bayley studies.
03Visual abnormalities, including nystagmus and strabismus, were reported in several methadone-exposed cohorts.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
There were no randomized trials, so groups may have differed in ways other than methadone exposure. Only one study was rated good quality; 26 were intermediate and 14 were poor quality. Attrition was high, with rates reported from 31% to 70% at 6 months and 18% to 84% at 2 years. Polydrug use was common and poorly reported, so methadone effects cannot be separated from other drugs. Comparison groups were often poorly described and not adequately controlled for socioeconomic status or environment. Preterm birth and treatment for neonatal abstinence syndrome were inconsistently reported, which can affect development. Only 15 of 41 studies were published in the past decade, and current methadone doses may be higher, so results may not match today's patients. The authors state that these associations do not prove harm from methadone.
Declared interests
The supplied text does not state author conflicts or a funder's role. The indexed publication type lists non-U.S. government research support.
The easy way to misread this
Do not conclude that methadone caused lower developmental scores or visual problems. The studies were observational, many mothers used other drugs, comparison groups were poorly matched, and the authors say causation cannot be inferred.