Opioid Maintenance Treatment during Pregnancy: Occurrence and Severity of Neonatal Abstinence Syndrome

Abstract

Background: Opioid maintenance treatment (OMT) is widely used to treat pregnant women with a history of opioid dependence. This study investigated whether maternal methadone/buprenorphine dose and nicotine use in pregnancy affects the occurrence and duration of neonatal abstinence syndrome (NAS) in the infant. Methods: Forty-one pregnant women from OMT programmes in Norway who gave birth between January 2005 and January 2007 were enrolled in a national prospective study. Thirty-eight women (81% of the population) were interviewed in the last trimester of pregnancy and 3 months after delivery. Data from the European Addiction Severity Index and a questionnaire measuring enrolled birth information were compared with medical records and urine analyses. Results: Treatment requiring NAS occurred in 58% of the methadone-exposed and in 67% of the buprenorphine-exposed infants. There was no significant relationship between a maternal dose of methadone or buprenorphine in pregnancy and NAS treatment duration for the infant. The mean number of cigarettes consumed correlated significantly with NAS treatment duration for the methadone group. Birth weight for the methadone group was approximately 200 g above international findings despite high doses during pregnancy. Conclusions: Maternal methadone/buprenorphine dose predicted neither the occurrence nor the need for NAS treatment for the infant.

Neonatal Abstinence Syndrome

“…[38][39][40] Multiple studies demonstrated that buprenorphine maintenance treatment in pregnancy is either comparable or superior to methadone treatment with regard to NAS; however, these studies were observational, retrospective, or small (Supplemental Table 5). [41][42][43][44][45][46][47][48] A larger prospective randomized study favored buprenorphine over methadone with regard to the doses and durations of morphine treatment and lengths of hospital stays, but not the incidence nor the severity of NAS. 49 A recent meta-analysis did not favor one over the other.…”

Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

“…Much information collected for this study was based on maternal self-report, which could result in inaccurate or socially desirable reporting. While drug and alcohol use may be underreported in self-report measures, the results from frequent urine controls during pregnancy suggests otherwise, as they were generally in agreement with self-report measures (Bakstad et al, 2009). Because both the outcome measure (CBCL) and independent maternal variables were mainly based on self-report, results may have been affected by similarities in the way the mothers responded on these questionnaires.…”

“…Neonatal data, including gestational age, birth weight, birth length, head circumference, and NAS was obtained from each child's medical record at birth. NAS was assessed using the modified Finnegan neonatal abstinence score or the Lipsitz score (see also Bakstad et al, 2009). Maternal drug and alcohol use as well as methadone or buprenorphine dose during pregnancy was measured with a structured interview administered in the last trimester of pregnancy.…”

“…All children were enrolled in a prospective longitudinal study and had been followed up since birth (Bakstad, Sarfi, Welle-Strand, & Ravndal, 2009). All pregnant women in OMT in Norway who had a pregnancy due date in the time period January 2005 and January 2007 were invited to participate in the prospective study.…”

“…The women had been in OMT on average two and half year before they became pregnant with the child followed in this study. The cohort is described in greater detail elsewhere (Bakstad et al, 2009;Lund, Brendryen, & Ravndal, 2014;Lund et al, 2012). Demographic and birth characteristics are listed in Table 1.…”