Infections and obstetric outcomes in opioid‐dependent pregnant women maintained on methadone or buprenorphine

Abstract

Aims To characterize infections and compare obstetrical outcomes in opioid-dependent pregnant women who participated in a randomized controlled trial comparing agonist medications, methadone and buprenorphine. Design Incidence of infections was identified as part of the screening medical assessment. As part of a planned secondary analysis, ANOVA and polytomous logistic regressions were conducted on obstetrical outcome variables using treatment randomization condition (maternal maintenance with either methadone or buprenorphine) as the predictor variable, controlling for differences between study sites. Setting Six United States sites and one European site that provided comprehensive treatment to opioid-dependent pregnant women. Participants Pregnant opioid-dependent women (n = 131) who delivered while participating in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study. Measurements Obstetrical, infectious, and other maternal medical complications captured by medical records, physical exam, blood tests, and self-report. Neonatal medical complications captured by medical records. Findings Hepatitis C (HCV) was the most common infection (32.3%), followed by hepatitis B (7.6%) and Chlamydia (6.1%) among participants at study enrollment. Maternal methadone versus buprenorphine maintenance was associated with a higher incidence of preterm labor (P = 0.04) and a significantly higher percentage of signs of respiratory distress in neonates at delivery (P = 0.05). Other medical and obstetrical complications were infrequent in the total sample, as well as in both methadone and buprenorphine conditions. Conclusions Buprenorphine appears to have an acceptable safety profile for use during pregnancy.

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

“…Of 1111 citations identified, 140 full‐text papers were assessed for eligibility, and 18 studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 (reported in 23 papers 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52) satisfied our inclusion criteria (Fig. 1).…”

“…1). The only three RCTs 19, 20, 21 (six papers 19, 20, 21, 50, 51, 52) that have been conducted to date were included (223 participants; published 2005–10) (Supporting information, Table S2). Fifteen OBSs 18, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 47, 48 (17 papers) 18, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 enrolled a total of 1923 participants in prospective 18, 34, 35, 36, 37, 38, 39, 41, 42, 45, 46, 47 ( n  = 12) or retrospective 43, 44, 48 ( n  = 3) cohort studies published 2001–15.…”

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

“…(42) Maternal methadone was associated with a higher incidence of preterm labor and more respiratory distress in neonates at the time of delivery. (49) Furthermore, methadone-exposed neonates had higher neonatal abstinence syndrome scores(50) and required earlier treatment with morphine than buprenorphine-exposed neonates. (51) The total neonatal abstinence syndrome score and the individual signs of tremors, hyperactive Moro reflex, excessive irritability, and failure to thrive were significantly higher among methadone-exposed neonates than their buprenorphine-exposed counterparts.…”

“…However, acetaminophen is contraindicated in those with hepatitis C, which could affect up to 30% of opioid-dependent women. (49) Clinical protocols for non-narcotic pain management after delivery and discharge should include ice packs and analgesic creams.…”

A Comparison of Opioid Using Women Attending High Risk Prenatal Clinic versus a Regular OB Clinic

“…Elevated rates of preterm birth (<37 weeks) at three times national average have been reported, as well as low birth weight (<2500 g), admission to neonatal intensive care [3] and need for extended treatment for Neonatal Abstinence Syndrome, which afflicts from 45% to 94% of newborns [4]. The effects of opioid dependence can have synergistic deleterious effects when they are in conjunction with other problems of drug using pregnant women including medical problems, sexually transmitted diseases, psychiatric disorders and polysubstance abuse [5]. Treatment at a high risk obstetrics clinic is critical to alleviate these problems.…”