[Drug abuse, pregnancy and HIV infection].

: It is estimated that there are between 50,000 and 90,000 drug abusers in the former West Germany. IV drug users are the second largest group of AIDS victims after homosexual and bisexual men. From 1989 to 1990, IV drug users up 16.1% of 1425 reported AIDS cases. 52% of 124 female AIDS cases were drug abusers. 4-12 weeks pass from the time of HIV infections to the appearance of HIV antibodies, thus testing is not foolproof. Heroin abuse often leads to oligo- or amenorrhea. yet 593 female IV drug users in New York City had 2289 pregnancies (often detecting their pregnancy too late for abortion), averaging 2.5 live births and 1.3 abortions. Fetal HIV transmission occurs in 20-40% of cases. The effectiveness of azidothymidine (AZT) prophylaxis is not clear. Only 29% of 50 HIV-infected women had complication-free pregnancies: 34% had premature pain and contractions, and 11 of 49 children were born prematurely before the 35th week. Drugs used include opiates, barbiturates, cocaine, cannabis, amphetamine, LSD, and mescaline. The daily cost of addiction leads to illegal activities. 80% of addicted women turn to prostitution. Methadone has been used for substitution in the US. In Germany, levomethadone (L-Polamidon) is approved and has a half time of 29 hours which is much longer than that of heroin. The heroin substitution regime consists of 4-5 ml of levomethadone and later 1-3 drops/day. Asphyxia of the fetus could occur in unmedicated withdrawal, necessitating the use of levomethadone even during pregnancy. The reduction of .2 ml of this drug every 2 days was well tolerated. Outpatient drug treatment is risky, it should be carried out only in maternal-child care facilities.