Maternal buprenorphine treatment and infant outcome

Abstract

Background and Objectives Maternal buprenorphine maintenance predisposes the infant to exhibit neonatal abstinence syndrome (NAS), but there is insufficient published information regarding the nature of NAS and factors that contribute to its severity in buprenorphine-exposed infants. Methods The present study evaluated forty-one infants of buprenorphine-maintained women in comprehensive substance use disorder treatment who participated in an open-label study examining the effects of maternal buprenorphine maintenance on infant outcomes. Modifiers of the infant outcomes, including maternal treatment and substance use disorder parameters, were also evaluated. Results Fifty-nine percent of offspring exhibited NAS that required pharmacologic management. Both maternal buprenorphine dose as well as prenatal polysubstance exposure to illicit substance use/licit substance misuse were independently associated with NAS expression. Polysubstance exposure was associated with more severe NAS expression after controlling for the effects of buprenorphine dose. Other exposures, including cigarette smoking and SRI use, were not related to outcomes. Maternal buprenorphine dose was positively associated with lower birth weight and length. Conclusions Polysubstance exposure was the most potent predictor of NAS severity in this sample of buprenorphine-exposed neonates. This finding suggests the need for interventions that reduce maternal polysubstance use during medication assisted treatment for opioid use disorder, and highlights the necessity of a comprehensive approach, beyond buprenorphine treatment alone, for the optimal care for pregnant women with opioid use disorders.

Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review

“…The third paper [ 48 ] found no correlation between nicotine or its metabolites in the meconium and NAS expression or neonatal outcomes (statistical analysis not provided). The fourth paper [ 49 ] concluded that maternal cigarette exposure had no impact on neonatal outcomes, including NAS severity ( p = 0.36). Note, all four papers that examined only buprenorphine had small sample sizes ( n = 10 [ 48 ]; n = 15 [ 47 ]; n = 23 [ 46 ]; and n = 41 [ 49 ]), which made it much less likely that a statistical difference attributable to tobacco consumption could be detected.…”

Functional MRI in prenatally opioid-exposed children during a working memory-selective attention task

“…Reports of lower birth weight associated with higher dose of methadone or buprenorphine at delivery in opioid maintained pregnant women could support this. 29,168,169 There is also evidence from animal research to support a causal effect of opioids on fetal growth. 170 However, there are myriads of associated risk factors, like poor maternal nutrition, maternal infections, and co-exposure to non-opioid drugs, and it is still unclear if opioids have a direct, causal effect on human fetal growth.…”

Prenatal opioid exposure: The next neonatal neuroinflammatory disease

“…24,25 Undoubtedly, the relationship between opioid exposure, neural circuitry changes and psychosocial factors are complex. [26][27][28][29] Indeed, pre-and postnatal environmental factors and stressors are important variables in the maturation of brain circuitry. 26,27,[30][31][32] Nontheless, the principal mechanisms of neural injury induced by opioids early in development remain a gap in knowledge.…”