Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation

Reddy, Uma M.; Davis, J. Madison; Ren, Zhaoxia; Greene, Michael F.

doi:10.1097/ogx.0000000000000517

Cited by 56 publications

(94 citation statements)

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“…4e6 The standard treatment approach to opioid use disorders in pregnancy includes initiation of medically assisted therapy (MAT) with long-acting opioids, traditionally methadone but more recently buprenorphine. 6,7 Compared with untreated opioid use disorder, medically assisted therapy has been associated with improved utilization of prenatal care, higher newborn birthweights, decreased risk of HIV infection, and lower rates of recidivism when compared with detoxification or medication-free treatment. 6,8 However, the use of MAT in pregnancy results in a risk of NOWS, which ranges from 47% to 57%.…”

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“…6,7 Compared with untreated opioid use disorder, medically assisted therapy has been associated with improved utilization of prenatal care, higher newborn birthweights, decreased risk of HIV infection, and lower rates of recidivism when compared with detoxification or medication-free treatment. 6,8 However, the use of MAT in pregnancy results in a risk of NOWS, which ranges from 47% to 57%. 6 A factor that may have an impact on the incidence and severity of NOWS is the dose of long-acting opioid therapy during pregnancy.…”

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confidence: 99%

“…6,8 However, the use of MAT in pregnancy results in a risk of NOWS, which ranges from 47% to 57%. 6 A factor that may have an impact on the incidence and severity of NOWS is the dose of long-acting opioid therapy during pregnancy. Published data on the relationship between methadone dosing in pregnancy and the incidence or severity of NOWS are conflicting, with some studies demonstrating positive correlations between methadone dose and NOWS 9e11 and others finding no association between these variables.…”

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Delivery dose of methadone, but not buprenorphine, is associated with the risk and severity of neonatal opiate withdrawal syndrome

Lappen

Stark

Bailit

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Data on the relationship between the dose of opioid replacement therapy in pregnancy and the risk and severity of neonatal opioid withdrawal syndrome are conflicting and have methodological limitations. OBJECTIVE: To assess the association of methadone and buprenorphine dose at delivery with neonatal opioid withdrawal syndrome in a large cohort. STUDY DESIGN: We performed a retrospective cohort study using data from a comprehensive perinatal opioid dependency program from 2000 through 2016. Women with a history of opioid use disorder enrolled in a medication-assisted treatment program were included. Strict neonatal opioid withdrawal syndrome case definition and neonatal treatment guidelines were utilized throughout the study epoch. Comparisons were made between women on methadone and buprenorphine. The dose of opioid replacement at delivery and the risk and severity of neonatal opioid withdrawal syndrome were assessed with univariable analysis and multivariable logistic regression. In all analyses, methadone and buprenorphine dosing were evaluated as a continuous variable. RESULTS: Four hundred eighty two of 709 women (68.0%) met inclusion criteria including 344 on methadone (71.4%) and 138 on buprenorphine (28.6%). Nonopioid polysubstance abuse, body mass index, medication-assisted treatment compliance, birthweight, and other characteristics were similar between groups. Overall, the frequency of neonatal opioid withdrawal syndrome was not significantly different between the methadone and buprenorphine groups (56.8% vs 52.0%, P ¼ .35). Dose at delivery ranged at 0e165 mg for methadone and 0e30 mg for buprenorphine. In a univariable analysis, methadone dose at delivery was associated with neonatal opioid withdrawal syndrome (83.0 AE 34.2 mg vs 71.9 AE 35.8 mg for neonatal opioid withdrawal syndrome vs nonneonatal opioid withdrawal syndrome neonates, P < .001), but buprenorphine dose at delivery was not (8.4 AE 4.4 vs 7.6 AE 4.8 mg for neonatal opioid withdrawal syndrome vs nonneonatal opioid withdrawal syndrome neonates, P ¼ .30). Peak neonatal opioid withdrawal syndrome score, duration of neonatal opioid withdrawal syndrome treatment, and cumulative neonatal morphine exposure were significantly associated with delivery methadone dose but not buprenorphine dose. The association between delivery methadone dose and neonatal opioid withdrawal syndrome persisted in multivariable regression. CONCLUSION: The dose of methadone at the time of delivery is associated with the frequency and severity of neonatal opioid withdrawal syndrome, with higher doses associated with more severe neonatal opioid withdrawal syndrome when analyzed continuously. These data may inform future prospective studies on methadone dosing in pregnancy. While medication-assisted treatment agent and dose may have an impact on pertinent neonatal outcomes related to neonatal opioid withdrawal syndrome, the provision of medication-assisted treatment in pregnancy should reflect the goal of prevention of recidivism and maternal mortality and ut...

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Delivery dose of methadone, but not buprenorphine, is associated with the risk and severity of neonatal opiate withdrawal syndrome

Lappen

Stark

Bailit

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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“…On top of the limitations of current scoring systems, disease severity in NOWS is known to be heterogenous and can be affected by a variety of clinical factors (e.g., types of utero opioid exposure, concomitant exposure to other substances, and gestational age) as well as genetic factors. 114,115 For these reasons, we could foresee limitations of using PD modeling based on withdrawal scores to guide dosing frequency in the weaning phase. On the other hand, there have been an increasing number of clinical studies aiming to simplify weaning protocols empirically.…”

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confidence: 99%

Clinical pharmacology and dosing regimen optimization of neonatal opioid withdrawal syndrome treatments

Tang

Bada

et al. 2021

Clinical Translational Sci

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“…The Centers for Disease Control and Prevention reported that the prevalence of OUD more than quadrupled in the United States from 1999 to 2014 (from 1.5/1000 deliveries to 6.5/1000) [1]. The mainstay of medical management is to place these patients on medications for opioid use disorder (MOUD) that use longer-acting opioid drugs such as methadone or buprenorphine [2][3][4][5][6]. These two medications are administered in daily oral/sublingual dosages.…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Extended-Release Buprenorphine Use in Pregnancy

Towers

Deisher

2020

Case Reports in Obstetrics and Gynecology

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Background. Opioid use disorder (OUD) in pregnancy is managed by medication-assisted treatment. Sublingual buprenorphine is one option, but subcutaneous extended-release buprenorphine (Sublocade®) is an alternate form administered in monthly injections. Through an extensive literature search, we did not find any prior publication on the use of Sublocade in pregnancy. Case. Two patients with OUD switched from sublingual buprenorphine to Sublocade. One patient received a total of eight injections and then discovered she was pregnant. Based on ultrasound dating, the last 5 administrations occurred during her pregnancy. The second patient received 6 injections with the last occurring at the time of her last menstrual period. Both declined further injections, as well as oral buprenorphine. Serial urine drug screens remained positive for buprenorphine through delivery in both cases. Neither the mothers nor the neonates experienced withdrawal symptoms or adverse outcomes. No birth anomalies were found. Discussion. Though further research is needed regarding the use of Sublocade in pregnancy, it is likely that other pregnancies will occur during this treatment modality. If this long-acting form of buprenorphine medication is found to be safe, it might play a role in managing some pregnant patients with OUD.

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Cited by 56 publications

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Delivery dose of methadone, but not buprenorphine, is associated with the risk and severity of neonatal opiate withdrawal syndrome

Delivery dose of methadone, but not buprenorphine, is associated with the risk and severity of neonatal opiate withdrawal syndrome

Clinical pharmacology and dosing regimen optimization of neonatal opioid withdrawal syndrome treatments

Subcutaneous Extended-Release Buprenorphine Use in Pregnancy

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