Tapering from Methadone or Buprenorphine during Pregnancy: Maternal and Neonatal Outcomes in Norway 1996-2009

Abstract

Background: The tapering of methadone or buprenorphine during pregnancy is an understudied and controversial issue. The aim of this study was to determine to what extent women tapered their opioid medication dose during pregnancy and what the neonatal outcomes were for those who tapered compared to the women who did not. Methods: The study was a mixed prospective/retrospective national cohort study of 123 Norwegian women in opioid maintenance treatment (OMT) during pregnancy and their neonates. A standardized questionnaire was administered to the women and medical information that could be used for verification was collected from hospitals and municipalities. Results: Two of the women came off the OMT-medication during pregnancy and another 15% tapered their OMT-medication dose more than 50%. The birth weights of methadone-exposed neonates of the women who tapered more than 50% were significantly higher than for the methadone-exposed neonates of the women tapering between 11 and 50%. No other significant differences were found. Conclusion: Pregnant women in OMT who taper their OMT-medication dose should be monitored closely. We need studies that document the maternal well-being and fetal safety of maternal tapering of the OMT-medication during pregnancy.

Treatment of Prescription Opioid Use Disorder in Pregnant Women

“…(10) Further, newborn outcomes including neonatal abstinence syndrome appear to be improved among women undergoing medication-assisted withdrawal. (5,10,39-41) At present, however it remains unclear if pregnant women with a prescription opioid use disorder that undergo medication-assisted withdrawal are at high risk for relapse to prescription opioid use or other drug use.…”

“…(5,10,39-41) One small study comparing opioid-assisted withdrawal (N=8) to methadone (N=12) or buprenorphine (N=5) in a comprehensive outpatient treatment program found no differences in maternal obstetric outcomes or urine drug screens between groups. (5) …”

“…Two national cohort studies completed in Norway (39) and Canada (40) reviewed the maternal and newborn outcomes of opioid-dependent women participating in outpatient opioid maintenance programs, who lowered their medication dose during pregnancy. A range of 40-80% of pregnant women with opioid use disorder were able to reduce their maintenance opioid medication and approximately 2-10% were able to completely stop opioid medication during pregnancy.…”

“…A range of 40-80% of pregnant women with opioid use disorder were able to reduce their maintenance opioid medication and approximately 2-10% were able to completely stop opioid medication during pregnancy. (39,40) At the time of delivery, 50-100% were successful at using only the reduced medication and had favorable newborn outcomes. (39,40) …”

Cerebral Magnetic Resonance Imaging in Children With Prenatal Drug Exposure

“…29,168,169 There is also evidence from animal research to support a causal effect of opioids on fetal growth. 170 However, there are myriads of associated risk factors, like poor maternal nutrition, maternal infections, and co-exposure to non-opioid drugs, and it is still unclear if opioids have a direct, causal effect on human fetal growth.…”