Abstract
INTRODUCTION: Treatments for opioid use disorder (OUD) in pregnancy remain understudied. The safety and efficacy of buprenorphine (BUP), a partial opioid agonist, and methadone, a full opioid agonist, in pregnancy has been established (1). Outside of pregnancy, the combination of BUP and naloxone (BUP-NX), a partial opioid antagonist, is commonly favored due to the decreased risk of diversion (2). Historically, women on BUP-NX are transitioned to BUP in pregnancy due to concerns for fetal exposure to naloxone (3,4). Recently, several small retrospective studies explored the use of BUP-NX in pregnancy and found no adverse maternal or neonatal outcomes (5,6). This is the first study to directly compare BUP-NX and BUP use in pregnancy. METHODS: This single-center, retrospective cohort study assessed 33 pregnancies managed with BUP-NX and 22 managed with BUP. Maternal outcomes included demographic characteristics, gestational age at treatment initiation, number of prenatal visits, gestational age at delivery, concurrent prescribed psychiatric medications, unprescribed or illicit substance use per urine drug screening, and delivery outcomes. Infant outcomes included birth weight, Apgar scores, and neonatal abstinence syndrome outcomes (diagnosis, treatment, and length of hospital stay). RESULTS: There was no significant difference in prenatal care utilization, maternal substance use, delivery outcomes, or neonatal outcomes. Among a subgroup of women transitioned from BUP to BUP-NX mid-pregnancy, no incidences of treatment destabilization were observed post-transition. CONCLUSION: Our study finds that BUP-NX is non-inferior to BUP in the treatment of OUD in pregnancy and supports the growing body of data indicating the safety of BUP-NX use in pregnancy.
Published Version
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