Association of Maternal Buprenorphine or Methadone Dose with Fetal Growth Indices and Neonatal Abstinence Syndrome

Abstract Objective Our objective was to compare fetal growth and incidence of neonatal abstinence syndrome requiring treatment across pregnant women with opioid use disorders on two types and two dose categories of medication-assisted treatment. Study Design A retrospective cohort study was conducted in a comprehensive, perinatal program in western North Carolina comparing growth percentiles on third-trimester ultrasound and at birth, and diagnosis of neonatal abstinence syndrome requiring treatment. Singletons were exposed in utero to low- to moderate-dose buprenorphine (≤16 mg/day; n = 70), high-dose buprenorphine (≥17 mg/day; n = 36), low- to moderate-dose methadone (≤89 mg/day; n = 41), or high-dose methadone (≥90 mg/day; n = 74). Multivariate analysis of variance with posthoc Bonferroni comparisons (p ≤ 0.01) and multinomial logistic regressions (adjusted odds ratio, 99% confidence interval) were conducted. Results Differences in neonatal outcomes reached statistical significance for larger head circumference for buprenorphine doses (p = 0.01) and for longer length (p < 0.01) and lower odds of neonatal abstinence syndrome requiring treatment (p < 0.01) with low- to moderate-dose buprenorphine versus high-dose methadone. Conclusion Among pregnant women using medication-assisted treatment for opioid use disorders, low- to moderate-dose buprenorphine (≤16 mg/day) was associated with the most favorable neonatal outcomes. However, more rigorous control of confounders with a larger sample is necessary to determine if low- to moderate-dose buprenorphine is the better treatment choice.

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Opioid Use in Pregnant Women and the Increase in Neonatal Abstinence Syndrome

Journal of Addiction Medicine ◽

10.1097/adm.0000000000000122 ◽

2015 ◽

Vol 9 (3) ◽

pp. 222-225 ◽

Cited By ~ 8

Author(s):

Kay Roussos-Ross ◽

Gary Reisfield ◽

Iain Elliot ◽

Susan Dalton ◽

Mark Gold

Keyword(s):

Pregnant Women ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Opioid Use

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A retrospective, observational study on medication for opioid use disorder during pregnancy and risk for neonatal abstinence syndrome

Family Practice ◽

10.1093/fampra/cmab121 ◽

2021 ◽

Author(s):

Ayesha Sujan ◽

Emma Cleary ◽

Edie Douglas ◽

Rubin Aujla ◽

Lisa Boyars ◽

...

Keyword(s):

Pregnant Women ◽

Clinical Sample ◽

Opioid Use Disorder ◽

Additional Benefit ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Opioid Use ◽

Relative Safety ◽

Increased Risk ◽

Exposure During Pregnancy

Abstract Objectives The prevalence of opioid use disorder (OUD) among pregnant women is increasing. Research consistently demonstrates the efficacy of medications for OUD (MOUD); however, researchers have called for additional studies evaluating the safety of MOUD during pregnancy, particularly the relative safety of two commonly used MOUD medications—methadone and buprenorphine. This study aimed to evaluate the consequences of MOUD exposure during pregnancy on risk for neonatal abstinence syndrome (NAS). Methods In a clinical sample of infants born to women with OUD, we evaluated the risk of NAS among those exposed to (i) methadone and (ii) buprenorphine compared with those unexposed to MOUD, as well as the risk of NAS among those exposed to (i) methadone compared with those exposed to (ii) buprenorphine. Results Compared with buprenorphine-exposed infants (n = 37), methadone-exposed infants (n = 27) were at increased risk for NAS (odds ratio [OR] = 4.67, 95% confidence interval [CI]: 1.03, 21.17). Compared with unexposed infants (n = 43), buprenorphine-exposed infants were at decreased risk for NAS (OR = 0.45, 95% CI: 0.14, 1.39) and methadone-exposed infants were at increased risk for NAS (OR = 2.64, 95% CI: 0.79, 8.76), though these associations were not statistically significant. Conclusions Our study suggests that when methadone and buprenorphine are equally appropriate options for the treatment of OUD in pregnant women, buprenorphine may add the additional benefit of reduced risk of newborn NAS.

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Comparison of buprenorphine and methadone in the management of maternal opioid use disorder in full term pregnancies

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0106 ◽

2020 ◽

Vol 48 (7) ◽

pp. 677-680

Author(s):

Cara L. Staszewski ◽

Diana Garretto ◽

Evan T. Garry ◽

Victoria Ly ◽

Jay A. Davis ◽

...

Keyword(s):

Length Of Stay ◽

Mode Of Delivery ◽

Opioid Use Disorder ◽

Neonatal Abstinence Syndrome ◽

P Value ◽

Abstinence Syndrome ◽

Opioid Use ◽

Term Infants ◽

Medication Assisted Treatment ◽

Methadone Group

AbstractObjectivesTo compare pregnancy outcomes with medication assisted treatment using. methadone or buprenorphine in term mothers with opioid use disorder.MethodsA cohort of women receiving medication assisted treatment with either methadone or buprenorphine were identified from delivery records over a 10‐year period. Women were excluded with delivery <37 weeks, multiple gestations, or a known anomalous fetus. Maternal demographics, medications, mode of delivery, birthweight, newborn length of stay, and neonatal abstinence syndrome were extracted. The study was IRB approved and a p-value of <0.05 was significant.ResultsThere were 260 women, 140 (53.8%) with methadone use and 120 (46.2%) with buprenorphine use. Groups were similar for maternal age, race, parity, homeless rate, tobacco use, mode of delivery and incidence of neonatal abstinence syndrome. The methadone group had a lower mean newborn birthweight (2874±459 g) and a greater incidence of low birth weight (11.4%) than the buprenorphine group (3282±452 g; p<0.001 and 2.5%; p=0.006). The incidence of neonatal abstinence syndrome was similar between groups (97% methadone vs. 92.5% buprenorphine; p=0.08). The methadone group had a longer newborn length of stay (11.4+7.4 days) and more newborn treatment with morphine (44.6%) than the buprenorphine group (8.2+4.4 days; p<0.001 and 24.2%; p<0.001). Maternal methadone use was an independent predictor for a newborn length of hospital stay >7 days (OR 3.61; 95% confidence interval 1.32–9.86; p=0.01).ConclusionsMedication assisted treatment favors buprenorphine use when compared to. methadone with an increased birthweight, reduced need for newborn treatment, and a shorter newborn length of stay in term infants.

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Buprenorphine versus Methadone During Pregnancy

10.1093/med/9780190625085.003.0036 ◽

2018 ◽

Author(s):

Rachel Wurmser ◽

Kirsten Wilkins

Keyword(s):

Mental Health ◽

Opioid Dependence ◽

Relevant Literature ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Opioid Use ◽

Alternative Treatment Option ◽

Hospital Stays ◽

Opioid Use Disorders ◽

Landmark Study

This chapter provides a summary of a landmark study in women’s mental health. The study addresses the question of whether buprenorphine is an alternative treatment option to methadone for pregnant women with opioid use disorders. The chapter describes the basics of the study, including funding, location, population studied, study design, interventions, results, and limitations. In short, the study demonstrated that neonates born to mothers with opioid dependence taking buprenorphine during pregnancy required less morphine for the treatment of Neonatal Abstinence Syndrome (NAS), shorter periods of treatment for NAS, and shorter hospital stays compared with neonates born to mothers treated with methadone. The chapter briefly reviews other relevant literature and discusses implications. It concludes with a case to help the reader apply the study to clinical practice.

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