Observational Study of Buprenorphine Treatment of Opioid-Dependent Pregnant Women in a Family Medicine Residency: Reports on Maternal and Infant Outcomes

O’Connor, Alane; Alto, William A.; Musgrave, Katje; Gibbons, Daniel C; Llanto, Lalaine; Holden, Selma; Karnes, Jonathan

doi:10.3122/jabfm.2011.02.100155

Cited by 31 publications

(23 citation statements)

References 23 publications

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“…Consistent with expectations (O’Connor et al, 2011), NAS symptoms peaked on day 3 of life. More than half of the infants (24, 58.5%) required pharmacotherapy for NAS; of these 3 (12.5%) required a second medication to control NAS symptoms.…”

Section: Resultssupporting

confidence: 88%

“…Cord blood concentrations of active metabolites norbuprenorphine and buprenorphine-glucuronide have been positively related with incidence of NAS requiring pharmacotherapy (Shah et al, 2016). However, most previous research has not found a relationship between maternal buprenorphine dose per se and NAS severity as defined by duration/incidence of NAS treatment, peak NAS score or duration of hospital stay (O’Connor et al, 2011; Jones et al, 2014; Bakstad et al, 2009; Metz et al, 2011), although one report suggested a relationship between dose and maximal NAS score that was not significant when the NAS score was above zero (Lejeune et al, 2006). Most of these studies did not consider other substance use (Jones et al, 2014; Lejeune et al, 2006) or considered only limited other substance use (Metz et al, 2011), were retrospective (O’Connor et al, 2011), used self-reported measures of other substance use as opposed to toxicology screens (Bakstad et al, 2009), or had small numbers of participants (O’Connor et al, 2011).…”

Section: Discussionmentioning

confidence: 97%

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Maternal buprenorphine treatment and infant outcome

Jansson

Vélez

McConnell

et al. 2017

Drug and Alcohol Dependence

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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.

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Section: Resultssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Maternal buprenorphine treatment and infant outcome

Jansson

Vélez

McConnell

et al. 2017

Drug and Alcohol Dependence

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“…Buprenorphine is gradually becoming a first‐line treatment over methadone as availability increases . However, a few small studies have found that women on methadone may be less likely to relapse than women using buprenorphine . The higher cost of buprenorphine is also a consideration, although recently, some third‐party payers have begun to cover buprenorphine treatment …”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

“…If symptoms persist 2 hours after the initial dose, an additional dose of 2 to 4 mg, up to a maximum of 16 mg in 24 hours, may be given . Dosing increases during the course of pregnancy are approximately 3 mg daily, primarily in the third trimester . The dosage is adjusted as withdrawal symptoms occur, keeping in mind that dosing requirements change as metabolic demands evolve during the pregnancy…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Opioid Use Disorder in Pregnancy

Roper

Cox²

2017

J Midwife Womens Health

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Opioid use disorder (OUD) in pregnancy has increased significantly in the past 10 years. Women with OUD may often be undertreated or untreated because of limited accessibility to treatment, particularly in rural areas. Because detoxification is not recommended during pregnancy due to the potential for adverse outcomes in the fetus and a high risk of relapse for the woman, more primary care providers need to be well versed in opioid-assisted therapy. In addition, recent changes in Food and Drug Administration regulations now allow nurse practitioners and physician assistants with specialized training to provide buprenorphine treatment for pregnant women with OUD in primary care settings. The purpose of this article is to provide information and guidance for clinicians working with and treating this population.

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“…Research on the relationship between buprenorphine dose and severity of NAS has typically failed to find any such relationship (Bakstad et al, 2009; Fischer et al, 2006; Kacinko et al, 2008, Lejeune et al, 2006; O'Connor et al, 2011). Metz et al (2011) also reported a failure to find relationships between buprenorphine dose and need for and amount of NAS medication, peak NAS score, and duration of NAS treatment in a sample of 26 neonates prenatally exposed to buprenorphine as part of comprehensive treatment program for maternal opioid use disorder.…”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy

Jones

Dengler

Garrison

et al. 2014

Drug and Alcohol Dependence

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Background Buprenorphine pharmacotherapy for opioid-dependent pregnant women is associated with maternal and neonatal outcomes superior to untreated opioid dependence. However, the literature is inconsistent regarding the possible existence of a dose-response relationship between maternal buprenorphine dose and neonatal clinical outcomes. Methods The present secondary analysis study (1) examined the relationship between maternal buprenorphine dose at delivery and neonatal abstinence syndrome (NAS) peak score, estimated gestational age at delivery, Apgar scores at 1 and 5 minutes, neonatal head circumference, length, and weight at birth, amount of morphine needed to treat NAS, duration of NAS treatment, and duration of neonatal hospital stay; and (2) compared neonates who required pharmacotherapy for NAS to neonates who did not require such pharmacotherapy on these same outcomes, in 58 opioid-dependent pregnant women receiving buprenorphine as participants in a randomized clinical trial. Results (1) Analyses failed to provide evidence of a relationship between maternal buprenorphine dose at delivery and any of the 10 outcomes (all p-values>.48); and (2) significant mean differences between the untreated (n=31) and treated (n=27) for NAS groups were found for duration of neonatal hospital stay and NAS peak score (both p-values<.001). Conclusions (1) Findings failed to support the existence of a dose-response relationship between maternal buprenorphine dose at delivery and any of 10 neonatal clinical outcomes, including NAS severity; and (2) that infants treated for NAS had a higher mean NAS peak score and, spent a longer time in the hospital than did the group not treated for NAS is unsurprising.

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Observational Study of Buprenorphine Treatment of Opioid-Dependent Pregnant Women in a Family Medicine Residency: Reports on Maternal and Infant Outcomes

Cited by 31 publications

References 23 publications

Maternal buprenorphine treatment and infant outcome

Maternal buprenorphine treatment and infant outcome

Opioid Use Disorder in Pregnancy

Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy

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