Jones et al. [Citation1] have criticized McCarthy’s recent article [Citation2] about the safety of the fetus when opioid-dependent pregnant women are withdrawn from methadone maintenance and/or undergo buprenorphine induction. Both the substance of the criticism and its harshness are difficult to comprehend.
McCarthy’s bottom line is simply that there is a need to “balance the debate on the use of methadone or buprenorphine [in the pregnant opioid-dependent woman] to include a concern for the acute and long-term adverse effects on the fetus.” Can there really be dispute over such a premise? The fact is that with respect to the consequences of different medications used in treatment of addiction during pregnancy the professional literature has focused mainly on the neonate and, to a lesser extent, on the expectant mother. By comparison, the fetus has received relatively little attention, and has been almost totally overlooked in the lay media coverage of reported research and clinical experience.
Whatever label one wishes to assign to the fetal response that may occur when opioid-dependent women go through withdrawal, Jones and her co-authors are correct in noting that many questions remain unanswered: “What is the relationship between severity of maternal withdrawal and fetal physiology/development, and if fetal effects exist, which are transitory, which are enduring, which are minor, which are major, and how such effects adversely affect fetal development.” Each of these “primary questions,” however, applies equally to the neonatal abstinence syndrome, which Jones et al. accept as a given.
Substantive disagreement among colleagues is, as McCarthy notes [Citation3] in his response to the criticism of Jones et al., “important for a dialogue concerning fetal withdrawal in opiate addiction treatment, a neglected area of research.” On the other hand, it detracts from productive, professional, intercourse when one party states that the position of the other “suggests poor scholarship or a bias.” The issues at hand are too important for the maternal-fetal dyad (there is nothing to support the assertion that McCarthy’s paper “pits the fetus against the mother”) to allow for such unwarranted aspersions.
Declaration of Interest: The authors report no conflicts of interest.
References
- Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, O’Grady KE, et al. Intrauterine abstinence syndrome (IAS) during buprenorphine inductions and methadone tapers: can we assure the safety of the fetus? J Matern Fetal Neonatal Med 2012;25:1197–1199.
- McCarthy JJ. Intrauterine abstinence syndrome (IAS) during buprenorphine inductions and methadone tapers: can we assure the safety of the fetus? J Matern Fetal Neonatal Med 2012;25(2):109–112.
- McCarthy JJ. Intrauterine abstinence syndrome (IAS) during buprenorphine inductions and methadone tapers: can we assure the safety of the fetus? J Matern Fetal Neonatal Med 2012;25(7):1199–1201.