Impact of Fentanyl Use on Maintenance Therapy During Pregnancy [40O

Abstract

INTRODUCTION: Little is known about the impact of fentanyl abuse on pregnancy care. We sought to investigate whether there is a difference in the pattern of opioid maintenance requirement among pregnant women who test positive for fentanyl at their initial titration compared to those who test negative. METHODS: We conducted a retrospective cohort review of pregnant patients admitted for initial buprenorphine (STX) or methadone (MTD) maintenance dosing from April 2015 to December 2015. Demographic characteristics and obstetrics outcomes in the fentanyl positive and fentanyl negative cohorts were compared using a student’s t-test or chi square as appropriate. We compared mean MTD or STX dose required among fentanyl positive compared to fentanyl negative patients using a student’s t-test. The small sample size allowed analysis only of crude data. RESULTS: Sixteen pregnant patients were admitted for initial STX or MTD maintenance titration. Seven of these patients (43.7%) tested positive for fentanyl on admission. There were no differences in baseline demographics or obstetric outcomes in the two cohorts. There was not a significant differences in dose requirement for fentanyl positive versus fentanyl negative patients (MTD: 45 mg vs 47 mg, p=0.68; 9mg vs 10 mg STX: p=0.12). Average maintenance dos at delivery was higher for fentanyl abusers on MTD maintenance compared to fentanyl non-abusers (90 mg vs 55 mg, p=0.04). CONCLUSION: There was no significant difference in MTD or STX requirement at initial titration, but the fentanyl positive cohort maintained on MTD did require a significantly higher dose by delivery.