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Association of Maternal Buprenorphine or Methadone Dose with Fetal Growth Indices and Neonatal Abstinence SyndromeFunding None.
Objective Our objective was to compare fetal growth and incidence of neonatal abstinence syndrome requiring treatment across pregnant women with opioid use disorders on two types and two dose categories of medication-assisted treatment.
Study Design A retrospective cohort study was conducted in a comprehensive, perinatal program in western North Carolina comparing growth percentiles on third-trimester ultrasound and at birth, and diagnosis of neonatal abstinence syndrome requiring treatment. Singletons were exposed in utero to low- to moderate-dose buprenorphine (≤16 mg/day; n = 70), high-dose buprenorphine (≥17 mg/day; n = 36), low- to moderate-dose methadone (≤89 mg/day; n = 41), or high-dose methadone (≥90 mg/day; n = 74). Multivariate analysis of variance with posthoc Bonferroni comparisons (p ≤ 0.01) and multinomial logistic regressions (adjusted odds ratio, 99% confidence interval) were conducted.
Results Differences in neonatal outcomes reached statistical significance for larger head circumference for buprenorphine doses (p = 0.01) and for longer length (p < 0.01) and lower odds of neonatal abstinence syndrome requiring treatment (p < 0.01) with low- to moderate-dose buprenorphine versus high-dose methadone.
Conclusion Among pregnant women using medication-assisted treatment for opioid use disorders, low- to moderate-dose buprenorphine (≤16 mg/day) was associated with the most favorable neonatal outcomes. However, more rigorous control of confounders with a larger sample is necessary to determine if low- to moderate-dose buprenorphine is the better treatment choice.
Keywordsneonatal abstinence syndrome - opioid use disorder in pregnancy - medication-assisted treatment
This study (preliminary analyses) was presented at the following conferences:
Lorencz E. Fetal growth and neonatal outcomes for pregnancies of women maintained on methadone versus buprenorphine. Paper presented at the Annual Meeting of the North Carolina Obstetrical and Gynecological Society, Charlotte, NC, April 2017.
Coulson CC, Lorencz E, Ramage M, Galvin SL. Comparison of buprenorphine versus methadone exposure in utero on fetal growth indices and neonatal abstinence syndrome. Poster presented at the 38th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, January 29 to February 3, 2018.
Coulson CC, Lorencz E, Ramage M, Galvin SL. Comparison of buprenorphine versus methadone exposure in utero on fetal growth indices and neonatal abstinence syndrome [Abstract]. Am J Obstet Gynecol 2018;1S:S141.
Received: 31 December 2018
Accepted: 28 June 2019
17 August 2019 (online)
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