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Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy

Oral Concurrent Sessions

Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy

(13) Investigating the Relationship Between Prenatal Methadone Exposure and Neonatal Withdrawal Using Cord Tissue Analysis

Wednesday, February 11, 2026

2:00 PM - 2:15 PM

Location: Summit 201 - 204

Submitting Author and Presenting Author(s)

Courtney Townsel, MD, MSc

Assistant Professor
University of Maryland School of Medicine
University of Maryland School of Medicine, Maryland, United States

Coauthor(s)

MT

Makeda Turner, BS

University of Maryland School of Medicine
Baltimore, Maryland, United States
FB

Fatemeh Abdollah Biroon, MD

University of Maryland School of Medicine
Baltimore, Maryland, United States
VG

Vedavalli Govindan, BS

Campbell University School of Osteopathic Medicine
Lillington, North Carolina, United States
Eric K. Broni, MD, MPH (he/him/his)

Resident
Yale University
New Haven, Connecticut, United States
Jeannie C. Kelly, MD, MS (she/her/hers)

Associate Professor
Washington University School of Medicine
Washington University School of Medicine, Missouri, United States

Objective:
Neonatal opioid withdrawal syndrome (NOWS) is more common among neonates exposed to methadone than buprenorphine prenatally. Despite this maternal dose of methadone does not predict severity of NOWS. We set out to assess whether umbilical cord methadone and metabolite levels are related to maternal methadone dose and NOWS severity.

Study Design:
Secondary analysis of a multi-site prospective study of pregnancies with opioid use disorder (OUD) between 2021-2025. Patients included if maintained on methadone, delivered ³34 weeks and had biospecimen collected at delivery. Major fetal anomalies and missing data were exclusions. Maternal and neonatal characteristics were abstracted. Umbilical cord tissue was collected after delivery, drained of blood, stored at -80°C and underwent mass spectrometry for quantification of methadone and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) levels. NOWS was defined as any Finnegan score >4; severe NOWS as requiring pharmacotherapy or Finnegan score >24 in 24 hours. Spearman correlations assessed relationships between maternal dose, cord drug levels and NOWS. P< 0.05 was significant.

Results:

Out of 83 patients with OUD, 49 were maintained on methadone. Patients were mostly non-Hispanic White (92%), multiparous (67%) and underwent cesarean (57%). NOWS was diagnosed in 90% (n=44) of neonates, with 57% (n=28) having severe NOWS. Maternal methadone dose strongly correlated with umbilical cord methadone (r=0.63, p< 0.001) and moderately correlated with umbilical cord EDDP (r=0.33, p=0.02). As maternal methadone dose increased so did cord methadone and EDDP levels (p< 0.001). Cord methadone and EDDP levels were not different between non-severe and severe NOWS cases. Cord EDDP, but not cord methadone, levels show a significant positive correlation with Finnegan scoring (r=0.38, p=0.02).

Conclusion:
Maternal methadone dose correlated with neonatal cord drug levels, but neither predicted NOWS severity. Cord EDDP levels showed a strong association with Finnegan scores and may be the best NOWS biomarker. NOWS severity likely involves factors beyond drug exposure.