Monday, December 5, 2022

Buprenorphine Associated With Fewer Birth Risks Than Methadone During Pregnancy

Pregnant people with opioid use disorder who are treated with buprenorphine may experience a lower risk of neonatal complications (such as preterm birth) than those taking methadone, according to a study in the New England Journal of Medicine. The study did not reveal differences in maternal outcomes (such as caesarean section) between the two groups, however.

“The standard care for treating pregnant persons with opioid use disorder is opioid agonist therapy with buprenorphine or methadone, which is associated with improved adherence to prenatal care, lower incidence of preterm birth, reduced return to opioid use, and fewer instances of opioid overdose and death from opioid overdose,” wrote Elizabeth Suarez, Ph.D., M.P.H., of Brigham and Women’s Hospital and colleagues. (Suarez has since taken a position at Rutgers University).

To determine if there were differences in neonatal and maternal outcomes of people taking these medications during pregnancy, the researchers studied more than 2.5 million pregnancies recorded in a national Medicaid database between 2000 and 2018. This sample included 10,704 pregnant persons taking buprenorphine and 4,387 taking methadone during the first 19 weeks of pregnancy, as well as 11,272 taking buprenorphine and 5,056 taking methadone during the second half of pregnancy. Suarez and colleagues compared the two groups on a range of birth-related outcomes: neonatal abstinence syndrome, preterm birth, small birth size for gestational age, low birth weight, cesarean section, and severe maternal complications (for example, acute heart failure, delirium, or sepsis).

Overall, compared with pregnant persons taking methadone early in pregnancy, those taking buprenorphine had a 42% reduced risk of having a preterm birth, 28% reduced risk of an infant born a small birth size for gestational age, and 44% reduced risk of an infant born at low birth weight; these results were similar in persons exposed to buprenorphine or methadone during late pregnancy. Persons taking buprenorphine in the 30 days prior to the birth of the baby also had a 27% reduced risk of having an infant with neonatal abstinence syndrome. There were no statistical differences in caesarean section or severe maternal complication risk between the two groups. 

“Persons who received buprenorphine may have received more comprehensive care in an office-based care setting than persons who received methadone in an opioid treatment program, which could have resulted in the underdiagnosis of health conditions in persons who received methadone,” Suarez and colleagues wrote. However, when the researchers limited the study population to those assumed to have received high-quality care, the findings were only slightly different. This suggests that the setting in which patients received care was not a factor in buprenorphine’s benefits.

Though this study suggests that buprenorphine leads to more favorable pregnancy outcomes, “[a]ny opioid agonist therapy is recommended over untreated opioid use disorder during pregnancy, because untreated persons have greater incidence of adverse outcomes owing to withdrawal, return to opioid use, overdose, intravenous drug use, and inadequacy of prenatal care,” the authors concluded.

To read more on this topic, see the Psychiatric News article “Pregnant Women Face Hurdles Accessing Opioid Treatment.”

(Image: iStock/Adene Sanchez)

Meet-the-Candidate Town Halls: Daily Through December 8

Learn more about the candidates in APA’s 2023 election through live, virtual meet-the-candidate town halls this week. The Tuesday town hall will feature the candidates for Area 2 Trustee (elected by Area 2 members only). The town halls will begin at noon ET and run 30 to 60 minutes. In the meantime, hear directly from the candidates by watching brief videos posted on APA’s website.





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