Methadone and Buprenorphine for Opioid Dependence During Pregnancy

Abstract

Objective To compare maternal characteristics, prenatal care and newborn outcomes in a cohort of opioid-dependent pregnant women treated with methadone vs. buprenorphine. Methods Retrospective cohort study. 609 pregnant, opioid-dependent women were treated with methadone (n=248) or buprenorphine (n=361) between 2000–2012 at a single institution. Results Mothers treated with buprenorphine were more likely to start medication prior to or earlier in pregnancy, had longer gestation and larger infants. Newborns of buprenorphine- vs. methadone-maintained mothers required treatment for neonatal abstinence significantly less often and for a shorter duration. Conclusions These data suggest pregnancy outcomes following buprenorphine to treat opioid dependence during pregnancy in clinical practice are as good and often better than outcomes with methadone. These results are consistent with efficacy data from randomized clinical trials and further support the use of buprenorphine for the treatment of opioid-dependence during pregnancy.

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

“…Of 1111 citations identified, 140 full‐text papers were assessed for eligibility, and 18 studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 (reported in 23 papers 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52) satisfied our inclusion criteria (Fig. 1).…”

“…The only three RCTs 19, 20, 21 (six papers 19, 20, 21, 50, 51, 52) that have been conducted to date were included (223 participants; published 2005–10) (Supporting information, Table S2). Fifteen OBSs 18, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 47, 48 (17 papers) 18, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 enrolled a total of 1923 participants in prospective 18, 34, 35, 36, 37, 38, 39, 41, 42, 45, 46, 47 ( n  = 12) or retrospective 43, 44, 48 ( n  = 3) cohort studies published 2001–15. No case–control studies were identified.…”

“…Statistical heterogeneity was low among the main analyses except for growth outcomes [birth weight (two RCTs, I 2  = 50%); LBW (two OBSs, I 2  = 62%); and SGA (two OBSs, I 2  = 50%)]. ROB was rated medium for each RCT ( n =  3, Supporting information, Table S3) and medium ( n  = 9) 18, 38, 39, 40, 41, 42, 43, 48, 49 or high ( n  = 8) 34, 35, 36, 37, 44, 45, 46, 47 for all OBSs (Supporting information, Table S4). Twelve OBSs assessed the balance between treatment groups for various confounding factors at study enrollment (Supporting information, Table S2), but only two OBSs adjusted for confounding factors in estimating treatment effects 39, 48.…”

“…EGA = estimated gestational age.aWe included one study that treated women with an abuse‐deterrent combination buprenorphine (BUP)–naloxone formulation 44, but excluded it from quantitative analyses.bPreterm birth was defined as < 36 completed weeks gestation in Colombini 2008 37.cSGA was defined as birth weight below: (a) 2 standard deviations from the sex‐ and gestational‐week specific mean value (Jones 2010 19; Kakko 2008 39); (b) 10th percentile of the sex‐ and gestational‐week specific mean value (Siedentopf 2004 47); or (c) the 5th percentile of the sex‐ and gestational‐week specific mean value (Brulet 2007 36; Meyer 2015 43). …”

“…SGA was defined as birth weight below: (a) 2 standard deviations from the sex‐ and gestational‐week specific mean value (Jones 2010 19; Kakko 2008 39); (b) 10th percentile of the sex‐ and gestational‐week specific mean value (Siedentopf 2004 47); or (c) the 5th percentile of the sex‐ and gestational‐week specific mean value (Brulet 2007 36; Meyer 2015 43). …”