Table 2.
Summary of Detoxification Process in Included Studies
| Author | Detoxification, n |
Setting | Trimester or Gestational Age at Detoxification, n (%)* |
Duration | Pharmacotherapy | Fetal Monitoring | Behavioral Health | Follow-up |
|---|---|---|---|---|---|---|---|---|
| Bell et al19 | 301 | Detoxification 1: jail | 1: 1st: 10 (9), 2nd: 65 (60), 3rd: 33 (31) | 1: NR | 1: Clonidine, antiemetic, antidiarrheal | FHT | 1: None | Delivery |
| Detoxification 2: inpatient | 2: 1st: 4 (17), 2nd: 10 (43), 3rd: 9 (39) | 2: 5–8 d | 2: Buprenorphine | 2: Residential or 8 h daily | ||||
| Detoxification 3: inpatient | 3: 1st: 12 (15), 2nd: 36 (47), 3rd: 29 (38) | 3: 5–8 d | 3: Buprenorphine | 3: None | ||||
| Detoxification 4: outpatient | 4: 1st: 2 (2), 2nd: 37 (40), 3rd: 54 (58) | 4: 8–16 wk | 4: Buprenorphine | 4: Ongoing outpatient | ||||
| Dooley et al20 | 86 | Outpatient | 1st: 14 (16), 2nd: 32 (37), 3rd: 32 (37) | 101 (SD±67) d† | Morphine (n=72); buprenorphine (n=8) | NR | Case-by-case basis | 7–10 d pp |
| Haabrekke et al25 | 21 | Residential‡ | 1st: 4 (19), 2nd: 7 (33), 3rd: 10 (48) | NR | Opioid agonists and pain medications for severe withdrawal | NR | During residential stay for up to 1 y after delivery | Delivery |
| Stewart et al27 | 95 | Inpatient | 20§ | 15–25 d‖ | Neonatal: n=12 for 4.5 y§§ | |||
| Lund et al28 | 8# | Inpatient | 22.8 (SD±8.3)† | 7 d | Methadone | >24 wk | Offered admission to outpatient drug rehabilitation facility¶ | Delivery |
| Jones et al26 | 123 | Inpatient | 20.3 (range 5–39)† | Detoxification 1: 3 d | Methadone | NR | Outpatient | Delivery |
| Detoxification 2: 7 d | Methadone | NR | Outpatient | Delivery | ||||
| Kahila et al21 | 67 | Outpatient | 1st: 38 (57), 2nd–3rd: 13 (21) | NR | Buprenorphine | BPP/growth >24 wk, NST >26 wk | NR | Delivery |
| Luty et al29 | 101 | Inpatient | 1st: 5 (5), 2nd: 54 (53), 3rd: 57 (56) | 19.5 (SE=1.1) d | Methadone | NR | NR | Delivery |
| Hulse et al33 | 18** | NR | 1st: 2 (11), 2nd: 11 (61), 3rd: 6 (33) | NR | Oral or IV sedation | US, n=4 | NR | Delivery |
| Sinha et al32 | 51 | NR†† | 2nd: 51 (100) | NR | Methadone‡‡ | NR | Outpatient during prenatal care | Delivery |
| Dashe et al24 | 34 | Inpatient | 24.2 (SD±8.1)† | 12 (range 3–39) d§ | Methadone for severe withdrawal, n=21; clonidine for mild withdrawal, n=13 | FHT | Outpatient during prenatal care | Delivery |
| Kyei-Aboagye et al22 | 30 | Residential | Up to the 2nd | NR | NR | NR | Part of residential program | Delivery |
| LePreau et al23 | 33 | Inpatient | 15.2 (range 4–36)† | 5 d | Clonidine, antiemetic and antidiarrheal medications | NST >32 wk | Daily group and individual counseling during detoxification, referred to outpatient counseling after detoxification¶ | Delivery |
| Maas et al31 | 58 | Initially inpatient then outpatient | 28 (range 9–40)§ | 9 (range 0–28) wk§ | Methadone | FHT | NR | Delivery |
| Wallach et al30 | 100 | Inpatient | NR | 10 d | Methadone | NR | 2–4 wk of inpatient counseling after detoxification | 6 wk pp |
| Neonatal: N=14 for 4 y |
NR, not reported; IV, intravenous; FHT, fetal heart tone auscultation, US, ultrasonography; NST, nonstress test; pp, postpartum; BPP, biophysical profile; SE, standard error.
*
n (%) unless otherwise specified.
†
Mean.
‡
n=8 pregnant women were involuntarily institutionalized.
§
Median.
‖
Median duration of detoxification for women with and without illicit drug use at delivery.
¶
Program attendance was not reported.
#
n=51 initiated detoxification, but data for women who did not complete detoxification were not reported.
**
One participant underwent detoxification twice.
††
n=1 patient had supervised withdrawal in prison.
‡‡
n=9 women underwent self-directed “cold turkey” withdrawal.
§§
Reported in Walhovd et al. 18