Buprenorphine-naloxone use in pregnancy: a subgroup analysis of medication to treat opioid use disorder

Link, Heather; Jones, Hendrée E.; Miller, Lauren A.; Kaltenbach, Karol; Seligman, Neil S.

doi:10.1016/j.ajogmf.2021.100369

Cited by 4 publications

(10 citation statements)

References 6 publications

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“…Studies on relatively new OMT, such as buprenorphine‐naloxone, are urgently needed 3,13,16–18 . However, research on drug abuse issues is challenging because of recruitment problems, social stigma, dropouts, compliance issues, and confounding factors.…”

Section: Discussionmentioning

confidence: 99%

“…3,13,[16][17][18] However, research on drug abuse issues is challenging because of recruitment problems, social stigma, dropouts, compliance issues, and confounding factors. In this study, we aimed at investigating OMT groups that were as pure as possible by including only mothers, who used the same OMT throughoutTA B L E 2 Medical diagnoses of the women on the opioid maintenance treatment Disease Finland, # Finnish general population.…”

mentioning

confidence: 99%

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Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Kanervo

Tupola

Nikkola

et al. 2022

Acta Obstet Gynecol Scand

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Introduction Current WHO guidelines recommend using methadone or buprenorphine as maintenance treatments for maternal opioid use disorder. However, buprenorphine‐naloxone, with a lower abuse risk than buprenorphine monotherapy or methadone, offers a potentially beneficial alternative, but scientific evidence on its effects on pregnancies, fetuses, and newborns is scarce. This paper compares the outcomes of the pregnancies, deliveries, and newborns of women on buprenorphine‐naloxone, buprenorphine, or methadone maintenance treatments. According to the hypothesis, as a maintenance treatment, buprenorphine‐naloxone does not have more adverse effects than buprenorphine, whereas methadone is more complicated. Material and methods In this population‐based study, 172 pregnant women on medical‐assisted treatments were followed‐up at Helsinki University Women's Hospital (Finland). Women receiving the same opioid maintenance treatment from conception to delivery and their newborns were included. Consequently, 67 mother–child dyads met the final inclusion criteria. They were divided into three groups based on their opioid pharmacotherapy. The outcomes were compared among the groups and, where applicable, with the Finnish population. Results The buprenorphine‐naloxone and buprenorphine groups showed similar outcomes and did not significantly differ from each other in terms of maternal health during pregnancies, deliveries, or newborns. Illicit drug use during the pregnancy was common in all groups, but in the methadone group it was most common (p = 0.001). Most neonates (96%) were born full‐term with good Apgar scores. They were of relatively small birth size, with those in the methadone group tending to be the smallest. Of the neonates 63% needed pharmacological treatment for neonatal opioid withdrawal syndrome. The need was lower in the buprenorphine‐based groups than in the methadone group (p = 0.029). Conclusions Buprenorphine‐naloxone seems to be as safe for pharmacotherapy for maternal opioid use disorder as buprenorphine monotherapy for both mother and newborn. Hence it could be a choice for oral opioid maintenance treatment during pregnancy, but larger studies are needed before changing the official recommendations. Women on methadone treatment carry multifactorial risks and require particularly cautious follow up. Furthermore, illicit drug use is common in all treatment groups and needs to be considered for all patients with opioid use disorder.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Kanervo

Tupola

Nikkola

et al. 2022

Acta Obstet Gynecol Scand

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“…The monoproduct is traditionally used in pregnancy because of concerns regarding fetal harm during opioid withdrawal; these concerns have since been debunked by opioid detoxification studies during pregnancy [39,40]. Several retrospective cohort studies have demonstrated no statistically significant differences in NOWS or return to use with the combination versus monoproduct, and meta-analyses suggest the combination product may be associated with lower rates of NOWS [41][42][43][44][45]. Overall, buprenorphine-naloxone does not appear to confer significant negative effect on fetal, neonatal, or birthing person outcomes.…”

Section: Key Pointsmentioning

confidence: 99%

Pharmacotherapy for opioid use disorder in pregnancy

Trammel,

Whitley,

Kelly

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Opioid use disorder (OUD) in pregnancy has significantly in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. Recent findings Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. Summary Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. Video http://links.lww.com/COOG/A94

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“…Methadone use has been associated with smaller birth size and more severe NOWS than buprenorphine. [5][6][7] A combination product of buprenorphine and naloxone has been developed to prevent parenteral abuse of buprenorphine, 8,9 but published data on its use during pregnancy are scarce. [8][9][10] This study aimed to investigate the effects of in-utero exposure to buprenorphine-naloxone, buprenorphine, or methadone on foetal and child growth and somatic health up to the age of two.…”

mentioning

confidence: 99%

“…[5][6][7] A combination product of buprenorphine and naloxone has been developed to prevent parenteral abuse of buprenorphine, 8,9 but published data on its use during pregnancy are scarce. [8][9][10] This study aimed to investigate the effects of in-utero exposure to buprenorphine-naloxone, buprenorphine, or methadone on foetal and child growth and somatic health up to the age of two. We hypothesised that the effects on the buprenorphine-and buprenorphinenaloxone-groups would be similar, but that the methadone group would be more compromised.…”

mentioning

confidence: 99%

Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

Kanervo,

Luoto,

Tupola

et al. 2024

Acta Paediatrica

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AimHow maternal opioid maintenance treatment (OMT) affects children is under‐researched. This population‐based registry study investigated child growth and somatic health following intrauterine exposure to this treatment.MethodsChildren born between 1 March 2011 and 30 May 2021 to mothers who used buprenorphine, buprenorphine‐naloxone, or methadone throughout their pregnancies were followed for 2 years at the Helsinki University Hospital, Finland. Appropriate statistical tests were used to compare the treatment groups.ResultsOf the 67 neonates, 52% were male, 96% were born full‐term and 63% were treated for neonatal opioid withdrawal syndrome. Otherwise, the children were predominantly healthy, although relatively small: 22% were small for gestational age, the methadone group children being the smallest. Foetal exposure to maternal methadone treatment, illicit drugs, hepatitis C and smoking were associated with small for gestational age; the former two were also associated with later slower growth, especially head growth and weight gain (p < 0.001). However, 29% were overweight at 2 years.ConclusionUsing child growth as the outcome, we found that buprenorphine‐naloxone and buprenorphine‐monotherapy had equal effects as forms of maternal OMT. Exposure to multiple risk factors may harm foetal and subsequent growth. We recommend long‐term follow‐up of children exposed to maternal OMT.

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Buprenorphine-naloxone use in pregnancy: a subgroup analysis of medication to treat opioid use disorder

Cited by 4 publications

References 6 publications

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Pharmacotherapy for opioid use disorder in pregnancy

Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

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