Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review

Abstract

Objective This study aimed to perform a systematic review of all studies reporting fetal outcomes following detoxification or tapering of opioid drugs during pregnancy. Study Design PubMed, Scopus, Medline, and Google Scholar were searched, and only manuscripts clearly reporting pregnancy/fetal outcomes involving tapering or detoxification from opioid drugs were included. Only pregnancies managed after 1980 were included (when antenatal fetal surveillance became more routine). Collected data included study design, location, years patients were managed, number of patients who were tapered or detoxified, method of tapering, and pregnancy outcome. Results A total of 14 publications met the criteria for review after evaluating more than 2,000 abstracts and 153 published manuscripts. In 1,097 pregnancies, based on mortality rate analyses and forest plots, no increased fetal risks due to tapering or detoxification from opioid drugs were identified. No increased risk of preterm delivery was found. Conclusion Pregnant women with opioid use disorder who are stable in a medication-assisted treatment program with behavioral health can be informed that tapering or full detoxification from opioid drugs does not increase the fetal risk of poor pregnancy outcome. Future research needs to answer the questions on maternal and long-term newborn consequences of tapering or detoxification versus long-term newborn consequences of continued chronic in utero opioid exposure.

Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis

“…4,31,32 Multiple subsequent studies have established that these risks were likely overstated, and recent systematic reviews have not demonstrated any increased risk of poor fetal outcome from tapering or detoxification in pregnancy. 33,34 Our findings further support that historic concerns regarding naloxone exposure in pregnancy are unfounded and should not drive MAT choice today. The pharmacokinetics of naloxone are such that following oral ingestion and metabolism, the drug remains inactive; however, intravenous or intramuscular injection will precipitate withdrawal.…”

Prenatal exposure to opioids.

“…Two systematic reviews and a meta-analysis failed to find the previously expected increase in negative outcomes in children, such as miscarriage, preterm births, reduced birth weight, and NAS, after tapering or detoxification relative to children born of women with continued use of opioids (Terplan et al, 2018;Towers et al, 2020;M. Wang et al, 2018).…”

“…Thus, a major concern has been maternal overdose and death after detoxification, as occurred postpartum for two women in an early study (Blinick et al, 1969). However, contemporary studies have not documented maternal death from detoxification during pregnancy; none were found in a structured review of 14 studies of opioid detoxification or tapering during pregnancy (Towers et al, 2020).…”

Anesthetic management of the parturient with opioid addiction

“…Medically supervised opioid withdrawal or detoxification in pregnant women with OUD is possible and has been suggested as an important strategy to decrease fetal exposure and opioidassociated fetal brain stress, [31][32][33][34][35][36][37][38] but needs to account for the possibility of maternal relapse and fetal withdrawals, which may result in fetal demise. 39 Rather, because it significantly reduces the risk of both relapse and withdrawal, MAT is the preferred treatment modality for pregnant women with OUD.…”