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We examined Ontario's population of pregnant women on MMT and determined the impact of timing of MMT initiation on perinatal outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women eligible for public drug benefits and on MMT during pregnancy between 2005 and 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We stratified women based on their timing of MMT initiation: (1) stabilized prior to conception, (2) newly initiated prior to conception, (3) initiation in trimester 1, (4) initiation in trimester 2 or (5) initiation in trimester 3. The primary outcomes in the multivariable logistic regression analysis were key perinatal health indicators: small for gestational age, preterm birth, congenital anomalies, severe maternal morbidity, caesarean section and induced labor. Secondary outcomes were specific to maternal opioid dependence: neonatal abstinence syndrome (NAS), admission to a neonatal intensive care unit (NICU), NAS treatment, removal from mother's custody at hospital discharge and neonatal death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Among 1842 women on MMT during pregnancy, 87.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01614) initiated MMT before conception. Almost a quarter of their infants (22.2%;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0408) were born small for gestational age, 17.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0323) were preterm and 5.9% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) range\u00a0=\u00a03.70\u20134.19] compared with those whose mothers were stabilized on MMT prior to conception.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Later initiation of methadone maintenance therapy among pregnant women in Ontario, Canada has not been found to be clearly related to most key perinatal adverse health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.14453","type":"journal-article","created":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T22:34:03Z","timestamp":1538433243000},"page":"268-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario"],"prefix":"10.1111","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6479-0510","authenticated-orcid":false,"given":"Qi","family":"Guan","sequence":"first","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Sproule","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy University of Toronto  Toronto Canada"},{"name":"Centre for Addiction and Mental Health  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone N.","family":"Vigod","sequence":"additional","affiliation":[{"name":"The Institute for Clinical Evaluative Sciences  Toronto Canada"},{"name":"The Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"},{"name":"Women's College Hospital and Research Institute  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne M.","family":"Cadarette","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy University of Toronto  Toronto Canada"},{"name":"The Institute for Clinical Evaluative Sciences  Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Greaves","sequence":"additional","affiliation":[{"name":"The Institute for Clinical Evaluative Sciences  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Martins","sequence":"additional","affiliation":[{"name":"The Institute for Clinical Evaluative Sciences  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":false,"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy University of Toronto  Toronto Canada"},{"name":"Li Ka Shing Knowledge Institute St Michael's Hospital  Toronto Canada"},{"name":"The Institute for Clinical Evaluative Sciences  Toronto Canada"},{"name":"The Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2016.11.009"},{"key":"e_1_2_8_3_1","unstructured":"The College of Physicians and Surgeons of Ontario.Methadone Maintenance Treatment: Program Standards and Clinical Guidelines [internet].2011. 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