Opioid Dependence During Pregnancy

Kaltenbach, Karol; Berghella, Vincenzo; Finnegan, Loretta P.

doi:10.1016/s0889-8545(05)70362-4

Cited by 254 publications

(209 citation statements)

References 41 publications

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“…28 Nevertheless, methadone treatment also has been related to the increased incidence of NAS. 12,29 Research on the pharmacokinetics of methadone during pregnancy has led to the administration of higher methadone doses than were used 20 years ago 30,31 ; however, it is unclear if these increases in maternal methadone dose have further increased the incidence of NAS. [32][33][34][35][36][37] Buprenorphine, a semisynthetic partial m-opioid receptor agonist and a complete k-opioid receptor antagonist, has been found to be equally safe and efficacious and has become an effective alternative to methadone for opioid dependency during pregnancy.…”

Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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Section: Growing Epidemiologymentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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“…The accepted treatment for OUD during pregnancy is long‐acting opioid agonist medication‐assisted treatment (OMAT), such as methadone (MET) or buprenorphine (BUP), within the context of a comprehensive program of obstetric care and psychosocial interventions 5, 8, 10, 11, 12, 13, 14. Adequate medication treatment maintains stable opioid blood levels that reduce maternal craving for and use of heroin or other opioids and improves prenatal care and fetal/infant outcomes compared with untreated opioid use or opioid withdrawal 11, 15, 16. MET maintenance treatment during pregnancy has been used widely since the early 1970s via daily visits to government‐regulated clinics 17.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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AimsTo assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.MethodsWe searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies.ResultsThree RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.ConclusionsModerately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

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“…Management of opioid-dependence with methadone has been used since the 1960's to improve maternal and neonatal outcome (3). Methadone maintenance is associated with more prenatal care, improved fetal growth, and increased likelihood of discharge to parents' care (4).…”

Section: Introductionmentioning

confidence: 99%