Buprenorphine Compared with Methadone in Pregnancy: A Systematic Review and Meta-Analysis

Kinsella, M.; Halliday, Lucy; Shaw, Martin; Capel, Y.; Nelson, Scott M.; Kearns, Rachel

doi:10.1080/10826084.2022.2083174

Cited by 18 publications

(8 citation statements)

References 44 publications

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“…Although most OST prescribing guidelines recommended methadone, a recent document from NHS Highland [ 131 ] suggested buprenorphine was preferred as there have been associated poor physical health outcomes for babies born to mothers prescribed methadone. Recent systematic review evidence suggests buprenorphine has better health outcomes for infants than methadone [ 138 ]. This highlights the need for guideline developers to ensure recommendations are informed by the most up to date evidence and are reviewed regularly as research evidence can change quickly, and its application can be complex as it may be dependent upon the women’s individual circumstances.…”

Section: Discussionmentioning

confidence: 99%

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

Gilmour,

Honeybul,

Lewis

et al. 2024

BMC Pregnancy Childbirth

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Background Women who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority. This scoping review aimed to (1) map clinical guidelines, treatment protocols and good practice guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within guidance. Methods We followed the Joanna Briggs International (JBI) guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories. Results Of 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base. Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies. Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care. Conclusions This synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.

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Section: Discussionmentioning

confidence: 99%

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

Gilmour,

Honeybul,

Lewis

et al. 2024

BMC Pregnancy Childbirth

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“…The landmark MOTHER trial comparing buprenorphine and methadone demonstrated lower rates of NOWS in the buprenorphine group; however, 33% of buprenorphine patients fell out of treatment [6]. A meta-analysis assessing 16 cohort studies and four randomized control trials demonstrated higher birth weight and body length, reduced prematurity, and lower risk of adverse events for birthing people in buprenorphine-exposed pregnancies relative to methadone, but also demonstrated higher dropout with buprenorphine [46]. A subsequent large cohort study of public insurance data demonstrated lower rates of NOWS, preterm birth, small for gestational age, and low birthweight in neonates exposed to buprenorphine, with no difference in cesarean deliveries or morbidity for the birthing person [47].…”

Section: First-line Agent Selectionmentioning

confidence: 99%

Pharmacotherapy for opioid use disorder in pregnancy

Trammel,

Whitley,

Kelly

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Opioid use disorder (OUD) in pregnancy has significantly in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. Recent findings Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. Summary Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. Video http://links.lww.com/COOG/A94

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“…5,6 Pregnant women with OUD are treated with BUP to manage opioid dependence or as an analgesic. 7 BUP is a semi-synthetic, long-acting opioid and possesses unique pharmacological actions through the partial agonist and antagonist effects on mu and kappa opioid receptors, respectively. BUP doses up to 32 mg/day are given sublingually to avoid extensive first-pass metabolism after oral administration for the management of opiate dependence.…”

Section: Introductionmentioning

confidence: 99%

“…The use of opioids in pregnancy is a public health issue that might have significant maternal, fetal, and neonatal adverse consequences 5,6 . Pregnant women with OUD are treated with BUP to manage opioid dependence or as an analgesic 7 . BUP is a semi‐synthetic, long‐acting opioid and possesses unique pharmacological actions through the partial agonist and antagonist effects on mu and kappa opioid receptors, respectively.…”

Section: Introductionmentioning

confidence: 99%

Simplified processing and rapid quantification of buprenorphine, norbuprenorphine, and their conjugated metabolites in human plasma using UPLC–MS/MS: Assessment of buprenorphine exposure during opioid use disorder treatment

Zhao,

Alshogran,

Zhang

et al. 2024

J Mass Spectrom

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Opioid use disorder (OUD) is a chronic neurobehavioral ailment and is prevalent in pregnancy. OUD is commonly treated with methadone or buprenorphine (BUP). Pregnancy is known to alter the pharmacokinetics of drugs and may lead to changes in drug exposure and response. A simple, specific, and sensitive analytical method for measuring the parent drug and its metabolites is valuable for assessing the impact of pregnancy on drug exposure. A new liquid chromatography–tandem mass spectrometric method that utilized a simple protein precipitation procedure for sample preparation and four deuterated internal standards for quantification was developed and validated for BUP and its major metabolites (norbuprenorphine [NBUP], buprenorphine‐glucuronide [BUP‐G], and norbuprenorphine‐glucuronide [NBUP‐G]) in human plasma. The standard curve was linear over the concentration range of 0.05–100 ng/mL for BUP and NBUP, and 0.1–200 ng/mL for BUP‐G and NBUP‐G. Intra‐ and inter‐day bias and precision were within ±15% of nominal values for all the analytes. Quality controls assessed at four levels showed high recovery consistently for all the analytes with minimal matrix effect. Adequate analyte stability was observed at various laboratory conditions tested. Overall, the developed method is simple, sensitive, accurate and reproducible, and was successfully applied for the quantification of BUP and its metabolites in plasma samples collected from pregnant women in a clinical study assessing BUP exposure during OUD treatment.

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Buprenorphine Compared with Methadone in Pregnancy: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 44 publications

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

Pharmacotherapy for opioid use disorder in pregnancy

Simplified processing and rapid quantification of buprenorphine, norbuprenorphine, and their conjugated metabolites in human plasma using UPLC–MS/MS: Assessment of buprenorphine exposure during opioid use disorder treatment

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