Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009

Abstract

The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs.

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

“…Only two studies treated essentially all women with MET from preconception to end of pregnancy 41, 48. Among the medium ROB RCT 19 and four OBSs 38, 41, 43, 48 that reported at least one defect, the treatment effect was not significantly different in magnitude or direction between BUP and MET (Table 2 and Fig.…”

“…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.…”

“…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. If not provided through an integrated, comprehensive prenatal addiction treatment program, MET was generally administered by standalone clinics or pharmacies while BUP was provided by office‐based practitioners.…”

“…Nine studies 19, 21, 34, 38, 39, 41, 43, 46, 48 that evaluated malformations or other defects at birth or pregnancy loss identified chromosomal defects and cardiovascular, central nervous system, craniofacial and musculoskeletal malformations (Supporting information, Table S7). Only two studies treated essentially all women with MET from preconception to end of pregnancy 41, 48.…”