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TOPLINE:

Higher doses and a longer duration of buprenorphine use throughout pregnancy for opioid use disorder (OUD) are associated with improved postpartum treatment retention and fewer overdose events, with no adverse neonatal outcomes.

METHODOLOGY:

• The retrospective study used data from the Pennsylvania Medicaid program to assess the effect of buprenorphine use on maternal and neonatal health outcomes in 2925 pregnant women with OUD (mean age, 29 years) who had a live birth from 2009 to 2019.
• The included women received at least two buprenorphine prescriptions and did not use methadone during pregnancy and postpartum. They were followed from the start of pregnancy through 90 days after birth.
• Three trajectory groups were identified: Those who initiated buprenorphine before pregnancy and had consistent usage throughout pregnancy, those who initiated buprenorphine during pregnancy, and those who used buprenorphine before pregnancy but discontinued it during pregnancy; varying doses were noted within each trajectory group.
• Outcomes include buprenorphine continuation after birth, overdose, weeks at delivery date, low birthweight (birthweight ≤ 2500 g at delivery), and neonatal abstinence syndrome.

TAKEAWAY:

• Women who consistently used buprenorphine at moderate doses (mean daily dose, 14.76 mg) were 81% more likely to continue its use after 90 days of delivery than those who consistently used high doses (mean daily dose, 22.35 mg; adjusted odds ratio [aOR], 1.81; 95% CI, 1.09-2.98).
• Second-trimester buprenorphine initiation at moderate doses was associated with 44% lower odds of postpartum treatment continuation than consistent usage at high doses (aOR, 0.56; 95% CI, 0.43-0.73).
• The rates of buprenorphine overdose either during pregnancy or after giving birth were higher among women who discontinued its use during pregnancy (18.3 per 1000 pregnant patients) and those who initiated it during pregnancy (21.9 per 1000) than among those who started the medication before pregnancy and maintained use (6.9 per 1000).
• The odds of having an infant with a low birthweight or with neonatal abstinence syndrome were not significantly different among women using different doses of buprenorphine during pregnancy.

IN PRACTICE:

“A longer duration of use and a higher dose of buprenorphine were associated with improved odds of continuing buprenorphine postpartum, less frequent overdose events, and were not associated with adverse neonatal outcomes. These results reiterate the importance of MOUD [medications for OUD] use during pregnancy to mitigate adverse outcomes associated with the opioid crisis,” the authors wrote.

SOURCE:

The study was led by Marian Jarlenski, PhD, MPH, of the Department of Health Policy and Management at the University of Pittsburgh School of Public Health, Pittsburgh. It was published online on December 05, 2024, in the American Journal of Obstetrics & Gynecology.

LIMITATIONS:

Fewer overdose events prevented adjusted analysis; however, data suggest that a longer duration of use with higher doses of buprenorphine may reduce overdoses. As an observational study, causality between buprenorphine use and the observed outcomes could not be established. The relatively homogeneous population from a single state may have limited generalizability.

DISCLOSURES:

This study was supported by grants from the National Institute on Drug Abuse. One author reported being an investigator on grants from the National Institutes of Health, Gilead, and Merck, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.