Effects of Methadone and Buprenorphine Use During Pregnancy on Neonatal and Maternal Outcomes [4K

Abstract

INTRODUCTION: The opioid epidemic in continues to be a major public health concern. Opioid use during pregnancy increases risks of adverse neonatal and maternal outcomes, including neonatal abstinence syndrome (NAS). Methadone and Buprenorphine are used as maintenance therapy for opioid dependence during pregnancy. Our objective is to compare effects of Methadone and Buprenorphine on maternal and neonatal outcomes. METHODS: This is a retrospective cohort study that included patients with a singleton pregnancy who received opioid maintenance therapy and delivered at Hurley Medical Center from 2012 - 2017. IRB approval was obtained. Primary outcome was length of neonatal stay. Demographic characteristics, illicit drug use, and tobacco smoking were among variables analyzed in the Methadone and Buprenorphine groups. RESULTS: The study included 228 participants. 47 were on Buprenorphine and 181 on Methadone. Of the neonates, 71% required treatment for NAS. The median length of treatment in days was significantly less in Buprenorphine group (p= 0.001; 10 vs 16), along with median length of stay (p= 0.000001; 12 vs 20). There was no association between Buprenorphine dose and NAS treatment. In the Methadone group, the median dose increased with the level of treatment (p=0.004). After correcting for potential confounders, we noted that gestational age, dose of methadone, and illicit drug use, were associated with higher risk of requiring NAS treatment. CONCLUSION: Neonates exposed to Buprenorphine had significantly lower rates of NAS and shorter NICU stay compared to Methadone. Gestational age at delivery, Methadone dose, and illicit drug use seem to be associated with increased NAS treatment.