Maintenance agonist treatments for opiate dependent pregnant women

Abstract

We didn't find any significant difference between the drugs compared both for mother and for child outcomes; the trials retrieved were too few and the sample size too small to make firm conclusion about the superiority of one treatment over another. There is an urgent need of big randomized controlled trials.

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

“…Integrated care that includes obstetric and addiction clinicians who communicate and coordinate a woman’s care in 1 location have demonstrated an increase in treatment retention, improved maternal and newborn outcomes, and cost-effectiveness . The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%) . The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth .…”

“…[26][27][28] The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%). 29 The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth. 9 Greater retention and duration of treatment of pregnant women with substance use disorders is associated with a reduction in the use of all substances, including tobacco; an increase in employment; higher income; a reduced likelihood of being arrested; a reduction in symptoms of depression; and more positive parenting attitudes.…”

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

“…Integrated care that includes obstetric and addiction clinicians who communicate and coordinate a woman’s care in 1 location have demonstrated an increase in treatment retention, improved maternal and newborn outcomes, and cost-effectiveness . The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%) . The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth .…”

“…[26][27][28] The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%). 29 The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth. 9 Greater retention and duration of treatment of pregnant women with substance use disorders is associated with a reduction in the use of all substances, including tobacco; an increase in employment; higher income; a reduced likelihood of being arrested; a reduction in symptoms of depression; and more positive parenting attitudes.…”

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

“…Variables influencing fetal growth and gestational age at delivery include smoking, multiple drug use and low socioeconomic status: all factors being prevalent in SMM in the present and previous studies (Cleary et al;, Fischer & Kopf, 2007, Simpson, 1957. While heroin has been associated with retarded fetal growth (Bada et al 2002, Minnes et al;2011, Minozzi et al;2008), the use of methadone has been shown to be associated with higher birth weights when compared to women who continued to use heroin. It has further been shown to HELP prevent premature labour so that fetuses exposed to methadone had a higher birth weight and less morbidity than heroin exposed babies (Finnegan et al;2010).…”

Changes in methadone maintenance therapy during and after pregnancy

“…Randomized clinical trials need to be conducted to determine whether there is less total daily dosing, higher patient satisfaction, or less NAS with twice daily dispensings with lower doses. Another research direction would be to compare methadone with buprenorphine, a partial mu agonist, if pregnant patients were either previously stabilized on buprenorphine before pregnancy or if they refused methadone (Martin et al, 2009;Minozzi, Amato, Vecchi, Davoli, 2008). Lastly, we are now comparing differences between gravid women on methadone maintenance therapy who have addictions to prescription opioids as opposed to illicit heroin use.…”

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

“…Integrated care that includes obstetric and addiction clinicians who communicate and coordinate a woman’s care in 1 location have demonstrated an increase in treatment retention, improved maternal and newborn outcomes, and cost-effectiveness . The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%) . The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth .…”

“…[26][27][28] The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%). 29 The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth. 9 Greater retention and duration of treatment of pregnant women with substance use disorders is associated with a reduction in the use of all substances, including tobacco; an increase in employment; higher income; a reduced likelihood of being arrested; a reduction in symptoms of depression; and more positive parenting attitudes.…”

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

“…Variables influencing fetal growth and gestational age at delivery include smoking, multiple drug use and low socioeconomic status: all factors being prevalent in SMM in the present and previous studies (Cleary et al;, Fischer & Kopf, 2007, Simpson, 1957. While heroin has been associated with retarded fetal growth (Bada et al 2002, Minnes et al;2011, Minozzi et al;2008), the use of methadone has been shown to be associated with higher birth weights when compared to women who continued to use heroin. It has further been shown to HELP prevent premature labour so that fetuses exposed to methadone had a higher birth weight and less morbidity than heroin exposed babies (Finnegan et al;2010).…”

Changes in methadone maintenance therapy during and after pregnancy

“…Randomized clinical trials need to be conducted to determine whether there is less total daily dosing, higher patient satisfaction, or less NAS with twice daily dispensings with lower doses. Another research direction would be to compare methadone with buprenorphine, a partial mu agonist, if pregnant patients were either previously stabilized on buprenorphine before pregnancy or if they refused methadone (Martin et al, 2009;Minozzi, Amato, Vecchi, Davoli, 2008). Lastly, we are now comparing differences between gravid women on methadone maintenance therapy who have addictions to prescription opioids as opposed to illicit heroin use.…”

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

“…Integrated care that includes obstetric and addiction clinicians who communicate and coordinate a woman’s care in 1 location have demonstrated an increase in treatment retention, improved maternal and newborn outcomes, and cost-effectiveness . The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%) . The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth .…”

“…[26][27][28] The rate of retention in telemedicine treatment in our study was similar to that of in-person integrated care (85.4% vs 91.7%) and also similar to that in prior studies of pregnant women receiving treatment for OUD, including methadone or buprenorphine, in integrated treatment centers (70%-80%). 29 The rates of retention in these programs are higher than those reported in nonintegrated programs, such as methadone treatment centers, where most women, on average, receive only 2.8 consecutive months of methadone treatment before giving birth. 9 Greater retention and duration of treatment of pregnant women with substance use disorders is associated with a reduction in the use of all substances, including tobacco; an increase in employment; higher income; a reduced likelihood of being arrested; a reduction in symptoms of depression; and more positive parenting attitudes.…”

Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study

“…Variables influencing fetal growth and gestational age at delivery include smoking, multiple drug use and low socioeconomic status: all factors being prevalent in SMM in the present and previous studies (Cleary et al;, Fischer & Kopf, 2007, Simpson, 1957. While heroin has been associated with retarded fetal growth (Bada et al 2002, Minnes et al;2011, Minozzi et al;2008), the use of methadone has been shown to be associated with higher birth weights when compared to women who continued to use heroin. It has further been shown to HELP prevent premature labour so that fetuses exposed to methadone had a higher birth weight and less morbidity than heroin exposed babies (Finnegan et al;2010).…”

Changes in methadone maintenance therapy during and after pregnancy

“…Randomized clinical trials need to be conducted to determine whether there is less total daily dosing, higher patient satisfaction, or less NAS with twice daily dispensings with lower doses. Another research direction would be to compare methadone with buprenorphine, a partial mu agonist, if pregnant patients were either previously stabilized on buprenorphine before pregnancy or if they refused methadone (Martin et al, 2009;Minozzi, Amato, Vecchi, Davoli, 2008). Lastly, we are now comparing differences between gravid women on methadone maintenance therapy who have addictions to prescription opioids as opposed to illicit heroin use.…”