Integrated care for pregnant women on methadone maintenance treatment: Canadian primary care cohort study

Article Figures & Data

Table 1.

Maternal demographic characteristics

CHARACTERISTIC	SITE			TOTAL COHORT (N = 102)	P VALUE
CHARACTERISTIC	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102)	P VALUE
Mean (SD) age at delivery, y	30.2 (5.2)	29.2 (5.4)	29.8 (6.0)	29.7 (5.4)	.718
Marital status, n (%)
• Single	24 (55)	23 (64)	3 (14)	50 (49)	.001^*
• Married or partnered	20 (45)	13 (36)	19 (86)	52 (51)	.001^*
Mean (SD) gravidity	3.6 (2.0)	3.7 (2.0)	3.7 (1.8)	3.6 (2.0)	.989
Mean (SD) parity	2.1 (1.1)	2.6 (1.4)	1.7 (0.8)	2.2 (1.2)	.017^*
Ethnicity, n (%)
• White	29 (66)	14 (39)	22 (100)	65 (64)	< .001^*
• Aboriginal	2 (4)	19 (53)	0 (0)	21 (20)	< .001^*
• Asian	6 (14)	1 (3)	0 (0)	7 (7)	.104
• Other	7 (16)	2 (5)	0 (0)	9 (9)	.077
Financial status, n (%)
• Employed	10 (23)	0 (0)	7 (32)	17 (16)	< .001^*
• Dependent on social assistance	25 (57)	26 (72)	11 (50)	62 (61)	.188
• Dependent on family or friends	6 (13)	1 (3)	2 (9)	9 (9)	.237
• No income or income from prostitution	3 (7)	9 (25)	2 (9)	14 (14)	.065
Living with children, n (%)	15 (34)	3 (8)	0 (0)	18 (18)	< .001^*

Table 2.

Living situation

LIVING SITUATION	SITE, N (%)			TOTAL COHORT (N = 102), N (%)	P VALUE
LIVING SITUATION	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102), N (%)	P VALUE
At first visit
• With partner	23 (52)	16 (44)	19 (86)	58 (57)	.005^*
• With parents, relatives, or friends	10 (23)	10 (28)	3 (14)	23 (22)	.463
• Alone	11 (25)	10 (28)	0 (0)	21 (21)	.012^*
At discharge
• With partner	25 (57)	9 (25)	19 (86)	53 (52)	< .001^*
• With parents, relatives, or friends	7 (16)	9 (25)	3 (14)	19 (19)	.517
• Alone	12 (27)	18 (50)	0 (0)	30 (29)	< .001^*

Table 3.

Housing status

HOUSING STATUS	SITE, N (%)			TOTAL COHORT (N = 102), N (%)	P VALUE
HOUSING STATUS	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102), N (%)	P VALUE
At first visit
• House or apartment	39 (89)	19 (53)	22 (100)	80 (78)	< .001^*
• Shelter	4 (9)	10 (28)	0 (0)	14 (14)	.006^*
• Homeless	1 (2)	7 (19)	0 (0)	8 (8)	.007^*
At discharge
• House or apartment	39 (89)	16 (44)	22 (100)	77 (75)	< .001^*
• Shelter	3 (7)	19 (53)	0 (0)	22 (22)	< .001^*
• Homeless	2 (4)	1 (3)	0 (0)	3 (3)	.797

Table 4.

Maternal health status

MEDICAL CONDITION	SITE, N (%)			TOTAL COHORT (N = 102), N (%)	P VALUE
MEDICAL CONDITION	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102), N (%)	P VALUE
Hepatitis B	0 (0)	2 (6)	2 (9)	4 (4)	.111
Hepatitis C	12 (27)	22 (61)	14 (64)	48 (47)	.002^*
Syphilis	0 (0)	2 (6)	0 (0)	2 (2)	NA
HIV	0 (0)	2 (6)	0 (0)	2 (2)	NA
Zidovudine use during labour	0 (0)	8 (22)	0 (0)	8 (8)	NA

Table 5.

Psychiatric conditions and treatment

PSYCHIATRIC CONDITION OR TREATMENT	SITE, N (%)			TOTAL COHORT (N = 102), N (%)	P VALUE
PSYCHIATRIC CONDITION OR TREATMENT	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102), N (%)	P VALUE
Psychiatric condition
• Major depression	16 (36)	21 (58)	9 (41)	46 (45)	.131
• Anxiety disorder	14 (32)	5 (14)	2 (9)	21 (21)	.058
• Other^*	5 (11)	8 (22)	4 (18)	17 (17)	.429
• Abuse (physical or sexual)	21 (48)	12 (33)	3 (14)	36 (35)	.023^†
• Suicidal thoughts or attempts	9 (20)	5 (14)	1 (5)	15 (15)	.224
Current pharmacotherapy
• Benzodiazepines	6 (14)	24 (67)	5 (23)	35 (34)	< .001^†
• Antipsychotics	0 (0)	4 (11)	0 (0)	4 (4)	NA
• Other^‡	16 (36)	10 (28)	9 (41)	35 (34)	.552

NA—not applicable.
↵* Includes schizophrenia, bipolar disorder, and eating disorders.
↵† Indicates significant difference at P < .05.
↵‡ Consists of selective serotonin reuptake inhibitors, selective noradrenergic reuptake inhibitors, trazodone, and bupropion.

Table 6.

Substance use in pregnancy

SUBSTANCE	SITE, N (%)			TOTAL COHORT, N (%)	P VALUE FOR DIFFERENCE BETWEEN SITES
SUBSTANCE	TORONTO	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT, N (%)	P VALUE FOR DIFFERENCE BETWEEN SITES
At first visit^*
• Alcohol	15 (34)	7 (19)	4 (18)	26 (25)	.220
• Nicotine	35 (80)	34 (94)	20 (91)	89 (87)	.142
• Cocaine or crack	14 (32)	27 (75)	4 (18)	45 (44)	< .001^†
• Heroin	7 (16)	29 (81)	11 (50)	47 (46)	< .001^†
• Marijuana	14 (32)	3 (8)	4 (18)	21 (21)	.034^†
• Benzodiazepines	15 (34)	6 (17)	4 (18)	25 (25)	.145
• Prescription opioids	21 (48)	4 (11)	3 (14)	28 (27)	< .001^†
At delivery^‡
• Alcohol	1 (3)	2 (6)	2 (9)	5 (5)	.635
• Nicotine	23 (64)	30 (83)	19 (86)	72 (77)	.070
• Cocaine or crack	4 (11)	10 (28)	4 (18)	18 (19)	.184
• Heroin	1 (3)	8 (22)	6 (27)	15 (16)	.010^†
• Marijuana	4 (11)	2 (6)	1 (4)	7 (7)	.687
• Benzodiazepines	4 (11)	16 (44)	5 (23)	25 (27)	.005^†
• Prescription opioids	4 (11)	2 (6)	3 (14)	9 (10)	.560

Table 7.

Total cohort substance use at first visit compared with at delivery

SUBSTANCE	TOTAL COHORT (TORONTO, VANCOUVER, MONTREAL), N (%)		P VALUE
SUBSTANCE	AT FIRST VISIT (N = 102)	AT DELIVERY (N = 94)	P VALUE
Alcohol	26 (25)	5 (5)	< .001^*
Nicotine	89 (87)	72 (77)	.052
Cocaine or crack	45 (44)	18 (19)	< .001^*
Heroin	47 (46)	15 (16)	< .001^*
Marijuana	21 (21)	7 (7)	.009^*
Benzodiazepines	25 (25)	25 (27)	.738
Prescription opioids	28 (27)	9 (10)	.001^*

Table 8.

Methadone dosing

METHADONE DOSING	SITE			TOTAL COHORT (N = 102)	P VALUE
METHADONE DOSING	TORONTO (N = 44)	VANCOUVER (N = 36)	MONTREAL (N = 22)	TOTAL COHORT (N = 102)	P VALUE
Taking methadone at conception, n (%)	25 (57)	12 (33)	16 (73)	53 (52)	.010^*
Mean (SD) gestational age at methadone initiation, wk	2.4 (8.9)	19.9 (7.9)	18.3 (9.6)	20.7 (8.4)	.506
Mean (SD) methadone dose, mg
• Before pregnancy	60.3 (51.4)	62.6 (34.3)	84.8 (26.9)	67.6 (42.8)	.208
• End of first trimester	59.2 (45.3)	64.3 (30.8)	74.1 (35.1)	64.6 (39.0)	.448
• End of second trimester	66.9 (47.0)	73.2 (38.3)	87.9 (36.0)	74.0 (42.0)	.202
• At delivery	73.5 (49.6)	85.7 (41.2)	93.9 (41.8)	82.4 (45.3)	.202
• Postpartum (up to 6 wk)	74.6 (49.1)	79.0 (41.0)	93.3 (41.2)	80.6 (44.5)	.288
Split dose, n (%)	10 (23)	18 (50)	7 (32)	35 (34)	.027^*