Buprenorphine Dosing Through the Pregnancy-to-Postpartum Transition: A Descriptive Analysis [ID 2683589

Abstract

INTRODUCTION: Supporting continuation of life-saving medications for opioid use disorder (OUD), like buprenorphine (BUP), is imperative through the postpartum period. However, no clinical guidelines exist to inform BUP dosing in this transition. Our study describes BUP dose changes in the first 3 months postpartum and associated patient characteristics in an OUD clinical sample. METHODS: This is a secondary analysis of an IRB-approved retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center, initiated BUP between January 1, 2018, and March 30, 2020, and remained on BUP until at least 3 months postpartum. The primary outcome was change in BUP dose between delivery and 3 months: a categorical variable with three levels (increase, decrease, or no change) abstracted from medical record. Bivariate analysis assessed the relationship between changes in BUP dosage and patient characteristics. RESULTS: In our sample (N=66), about half maintained their BUP dosage through 3 months postpartum (n=36; 55%); the remaining patients decreased (n=22; 33%) or increased their dose (n=8; 12%). 38% of patients incarcerated at delivery increased their dose, whereas 9% of patients not incarcerated increased their dose. 39% of patients who delivered vaginally decreased their dose; 24% of patients who delivered via cesarean section decreased their dose. CONCLUSION: Our study takes a crucial first step in developing the evidence base for the individualization of BUP dosing for postpartum people. Ultimately, we aim to use these data to inform a decision aid to facilitate shared decision-making about BUP dose changes in the pregnancy-to-postpartum transition.