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

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.

BUPRENORFINA vs. METADONA NO TRATAMENTO DE TRANSTORNO DE USO DE OPIOIDES DURANTE A GESTAÇÃO

“…[11] Em comparação com os bebês expostos à buprenorfina, os bebés expostos à metadona apresentavam um risco aumentado estatisticamente significativo de síndrome de abstinência neonatal. [15] Dentro da amostra, identificamos restantes associadas a diagnósticos de transtornos psiquiátricos (7,9%), diagnósticos de drogas e álcool e transtornos psiquiátricos (13,2%) e uma mistura de outras doenças relacionadas à gravidez.…”

Family Practice substance use disorder theme issue: commentary

“…There is a great need to develop improved strategies for treating withdrawal in opioid tapering. There remains concern about the safety of medications for OUD during pregnancy, which was investigated by Sujan et al 12 In this retrospective cohort, the risk of neonatal abstinence syndrome was more than 4 times greater when pregnant women received methadone compared with buprenorphine.…”

Methadone and Morphine for the Treatment of Neonatal Abstinence Syndrome: A Comparison of Safety and Efficacy

“…Opioids are prescribed for controlling chronic pain during pregnancy. Above 5% of pregnant women experience adverse effects due to the misuse of opioids (Sujan et al, 2022). As the consumption of psychotropic medications and opioids among pregnant women has increased, thus occurrence of neonatal abstinence syndrome (NAS) has increased (Maalouf et al, 2019).…”