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The British Journal of Psychiatry (2004) 184: 182-183
© 2004 The Royal College of Psychiatrists

Correspondence

A. Whittaker

Primary Care Facilitator Team (HIV/Drugs), Lothian Primary Care NHS Trust, 22 Spittal Street, Edinburgh EH3 9DU, UK

C. McIntosh

Rehabilitation Services, Royal Edinburgh Hospital, Morningside Road, Edinburgh EH10 5HF, UK

The article by Johnson et al (2003) was disappointing as they failed to present a balanced view of this topic. It is, of course, important to discuss possible effects of drug misuse on pregnancy, but to emphasise them without due and thorough consideration of the many confounding factors in this area is misleading. These include smoking, alcohol use, social deprivation, poor nutrition, quality of antenatal care and drug treatment, as well as accessibility of services. Clearly, these are additional factors that drug-misusing women will have to contend with. Well-designed, unconfounded studies in this area are rare, which means that findings on the specific effects of illicit drugs are inconsistent and contradictory (Ford & Hepburn, 1997).

The article failed to reflect that much of the recent work in this area has looked at flexibility of treatment services and equity of access. Women drug users are deterred from engaging with health and social care providers because of judgmental attitudes (Klee et al, 2002). We felt that the article had an unsympathetic tone, and had missed the point that the onus is on treatment services to make themselves accessible to women who may have chaotic lives. Our approach to care is crucial if we are to retain these women in treatment throughout pregnancy, and this support needs to flow seamlessly into the postnatal period.

There is a relationship between maternal methadone dose and severity of neonatal abstinence syndrome, but this is not a close one (Johnstone, 1998). The onset, duration and severity of neonatal abstinence syndrome is multi-factorial and related to the infant's metabolism, gestational age and central nervous system maturity. It is essential to work with parents to prepare them for the possibility of neonatal abstinence syndrome and to try to involve them in the management of this condition.

Johnson et al (2003) have provided us with a comprehensive list of possible unfavourable outcomes, but a more measured picture of the many difficulties that face both clients and health care professionals in this area would have better informed the Journal's readership.

REFERENCES

  1. Ford, C. & Hepburn, M. (1997) Caring for the pregnant drug user. In Care of Drug Users in General Practice: A Harm-Minimisation Approach (ed. B. Beaumont), pp. 107 -122. Oxford: Radcliffe Medical.
  2. Johnson, K., Gerada, C. & Greenough, A. (2003) Substance misuse during pregnancy. British Journal of Psychiatry, 183, 187 -189.[Free Full Text]
  3. Johnstone, F. (1998) Pregnant drug users. In Management of Drug Users in the Community: A Practical Handbook (ed. J. R. Robertson), pp. 299 -327. London: Arnold.
  4. Klee, H., Jackson, S. & Lewis, S. (2002) Drug Misuse and Motherhood. London: Routledge.
 

Author's reply

A. Greenough

Department of Child Health, King's College Hospital, London SE5 9RS, UK

We thank Drs Whittaker and McIntosh for their interest in our article, but they have misinterpreted its contents. As stated, the aim of our editorial was to emphasise the importance of the topic by describing the unfavourable effects illicit substances can have on both pregnancy and infant outcome; we are therefore pleased that Whittaker and McIntosh state we have provided a comprehensive list of unfavourable outcomes. We agree that treatment services should be accessible to women, as it is important to retain them throughout pregnancy and provide support through into the postnatal period. Indeed, in the final paragraph of our editorial we described such a package of care. We are surprised that Whittaker & McIntosh feel that our article had an unsympathetic tone; careful reading of our editorial demonstrates that it emphasises the importance of optimising treatment and reducing morbidity and argues for adequate resources to be made available.





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