Opioid Use Disorder and Perinatal Outcomes

Piske, Micah; Homayra, Fahmida; Min, Jeong Eun; Zhou, Haoxuan; Marchand, Carolyn; Mead, Annabel; Ng, Jennifer; Woolner, Megan; Nosyk, Bohdan

doi:10.1542/peds.2021-050279

Cited by 26 publications

(31 citation statements)

References 34 publications

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“…The need was lower in the buprenorphine-based groups than in the methadone group, which is in line with the clinical experience and the literature (maternal buprenorphine associated with less severe NOWS). 8,28,29 Of note, even though the average daily dose of buprenorphine during the pregnancy was higher in the buprenorphine-naloxone group than in the buprenorphinemonotherapy group, the former infants did not suffer more from NOWS than the latter.…”

Section: Discussionmentioning

confidence: 92%

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Kanervo

Tupola

Nikkola

et al. 2022

Acta Obstet Gynecol Scand

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Introduction Current WHO guidelines recommend using methadone or buprenorphine as maintenance treatments for maternal opioid use disorder. However, buprenorphine‐naloxone, with a lower abuse risk than buprenorphine monotherapy or methadone, offers a potentially beneficial alternative, but scientific evidence on its effects on pregnancies, fetuses, and newborns is scarce. This paper compares the outcomes of the pregnancies, deliveries, and newborns of women on buprenorphine‐naloxone, buprenorphine, or methadone maintenance treatments. According to the hypothesis, as a maintenance treatment, buprenorphine‐naloxone does not have more adverse effects than buprenorphine, whereas methadone is more complicated. Material and methods In this population‐based study, 172 pregnant women on medical‐assisted treatments were followed‐up at Helsinki University Women's Hospital (Finland). Women receiving the same opioid maintenance treatment from conception to delivery and their newborns were included. Consequently, 67 mother–child dyads met the final inclusion criteria. They were divided into three groups based on their opioid pharmacotherapy. The outcomes were compared among the groups and, where applicable, with the Finnish population. Results The buprenorphine‐naloxone and buprenorphine groups showed similar outcomes and did not significantly differ from each other in terms of maternal health during pregnancies, deliveries, or newborns. Illicit drug use during the pregnancy was common in all groups, but in the methadone group it was most common (p = 0.001). Most neonates (96%) were born full‐term with good Apgar scores. They were of relatively small birth size, with those in the methadone group tending to be the smallest. Of the neonates 63% needed pharmacological treatment for neonatal opioid withdrawal syndrome. The need was lower in the buprenorphine‐based groups than in the methadone group (p = 0.029). Conclusions Buprenorphine‐naloxone seems to be as safe for pharmacotherapy for maternal opioid use disorder as buprenorphine monotherapy for both mother and newborn. Hence it could be a choice for oral opioid maintenance treatment during pregnancy, but larger studies are needed before changing the official recommendations. Women on methadone treatment carry multifactorial risks and require particularly cautious follow up. Furthermore, illicit drug use is common in all treatment groups and needs to be considered for all patients with opioid use disorder.

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Section: Discussionmentioning

confidence: 92%

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Kanervo

Tupola

Nikkola

et al. 2022

Acta Obstet Gynecol Scand

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“…Além disso, foi relatado recentemente que o uso de opióides na gravidez se correlaciona com maior risco de sangramento do terceiro trimestre, sepse materna, déficits neurocomportamentais e síndrome de abstinência no neonato. Os sintomas de abstinência de opióides neonatais não são incomuns em neonatos expostos à heroína e à metadona (COOK et al, 2017;PISKE;HOMAYRA;MIN, 2021).…”

Section: Opióidesunclassified

Efeitos do consumo de substâncias tóxicas em neonatos e as principais complicações obstétricas

Becker¹,

Rosa²

2022

BJDV

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O uso de substâncias tóxicas é considerado um grande problema de saúde pública, com efeitos deletérios sobre a mãe e o feto, além de complicações obstétricas importantes. Esta revisão trata-se de um estudo do tipo bibliográfico com análise qualitativa e integrativa de literatura, com o propósito de reunir e sintetizar resultados de pesquisas sobre os principais efeitos do consumo de substâncias tóxicas em neonatos e as principais complicações obstétricas observadas, fornecendo compreensão mais profunda do tema investigado. Dados foram coletados de artigos indexados nos bancos de dados: SciELO (Scientific Eletronic Library Online) e LILACS, utilizando as palavras-chave: “abuso de drogas, consumo de drogas durante a gestação, consumo de drogas e neonatos” sozinhas e em combinação. Foram selecionados 20 artigos, publicados entre 2002 e 2022. As principais substâncias de abuso relatadas foram álcool, cocaína, crack, opioides e cannabis, sendo o álcool a droga lícita mais consumida e a cannabis, a droga ilícita, sendo que elas provocam diferentes alterações fetais. Tais alterações compreendem distúrbios no desenvolvimento neurológico, cognitivo e comportamental, além de impactos negativos sociais ao longo da vida. Entre as principais complicações obstétricas estão sangramento, descolamento placentário, parto prematuro e aborto. Além disso, respostas alteradas aos anestésicos no momento do parto também podem ser observadas. Em conclusão, observa-se a necessidade do aprimoramento de políticas sociais para diminuir os efeitos prejudiciais do consumo de drogas para a sociedade.

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“…In the United States, opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths ( 1 ). Medications for OUD (MOUD), including buprenorphine (BUP), reduce overdose risk and improve perinatal outcomes ( 2 ). One important factor influencing OUD treatment continuation is the involvement of the criminal legal system ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

Nguyen

Shadowen

et al. 2023

Front. Psychiatry

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IntroductionOpioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients’ incarceration status at the time of BUP initiation.MethodsThis is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status.ResultsOur sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02).ConclusionIn our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.

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Opioid Use Disorder and Perinatal Outcomes

Cited by 26 publications

References 34 publications

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Buprenorphine‐naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder

Efeitos do consumo de substâncias tóxicas em neonatos e as principais complicações obstétricas

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

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