154: Buprenorphine for pharmacotherapy of OUD in pregnancy: Does treatment setting matter?

Abstract

Buprenorphine is now commonly used as the first-line opioid pharmacotherapy for pregnant women with opioid use disorder (OUD), but little is known regarding effects of treatment setting on outcomes. The objective of this study is to determine whether there are differences in treatment characteristics and neonatal outcomes between pregnant women receiving buprenorphine in private practice (PP) versus outpatient treatment programs (OTP). Retrospective cohort study of pregnant women receiving buprenorphine at an urban, academic medical center from 2011 to 2017. Women were divided into two groups by OUD treatment setting: PP versus OTP. Unadjusted and adjusted analyses were performed to assess differences in treatment and neonatal outcomes. Comparison of means was performed using T-test. Hepatitis C status, smoking, maternal age, race/ethnicity, parity, gestational diabetes, pre-eclampsia, dose at delivery and use of buprenorphine at conception were included in the adjusted analyses. 107 pregnant women were included of which 70 (65.4%) received buprenorphine at a PP and 37 (34.6%) received buprenorphine at an OTP. Women treated at a PP were less likely to have been receiving buprenorphine prior to conception than those treated at an OTP (63% versus 83%, p <0.05; Table 1). Buprenorphine dose during first and second trimesters were similar, however women in the PP group received approximately 4mg more buprenorphine in the third trimester and at delivery than women in the OTP group (p<0.01). These differences reflect the tendency for women treated at an OTP to be on lower doses at delivery compared to the first or second trimester. There was no significant difference in neonatal outcomes with the exception of head circumference which was larger in the OTP group even after adjusting for confounding (0.97 cm, adj. p= 0.047; Table 2). There were several differences in treatment characteristics between pregnant women receiving buprenorphine for OUD at a PP versus OTP including higher delivery dose and a lower likelihood of dose reduction during pregnancy. However, neonatal outcomes were similar with the exception of a small difference in head circumference. The reason for the difference in treatment characteristics requires further study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)