Diazepam abuse in pregnant women on methadone maintenance. Implications for the neonate.

The authors found that the course and treatment of narcotic withdrawal in two neonates was complicated by prenatal exposure to high doses of diazepam, or Valium (Roche Laboratories, Nutley, NJ). Both of the mothers were on methadone maintenance for narcotic dependency prior to the diagnosis of pregnancy. The authors documented maternal intake of diazepam in the range of 40-60 mg/day for a duration of 4-27 weeks prior to delivery. Both infants initially responded well to medical therapy for narcotic withdrawal, but at 7-14 days of age, withdrawal symptoms intensified, requiring an increase in the dosages of Paregoric (UDL Laboratories, Rockford, IL) and opium tincture in both infants and the addition of phenobarbital therapy in one infant. Both infants continued on medical therapy until they reached 1 month of age. Diazepam use by pregnant women can be associated with a later presentation of withdrawal symptoms in the neonate than that induced by the use of other drugs. Close follow-up during the first month of life is warranted for infants exposed to diazepam prenatally.