• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Treating Opioid Use Disorder in Pregnancy: Is Buprenorphine or Methadone Better?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • The MOTHER trial (see ‘Primary Sources – Learn More’ below) reported that infants exposed to buprenorphine, compared to methadone, experienced better outcomes
    • However, loss to follow-up and relatively small sample size in the in the trial may have falsely improved outcomes in the buprenorphine group and results may have been imprecise or possibly confounded
  • Data on maternal outcomes are rare
  • Suarez et al. (NEJM, 2022) assess the risks of adverse neonatal and maternal outcomes associated with the use of buprenorphine as compared with methadone in pregnancy

METHODS:

  • Retrospective cohort study
    • Pregnancy cohort nested in nationwide Medicaid data
    • 2000 through 2018
    • Beneficiaries from 47 states and Washington, DC 
  • Population
    • Pregnancies that ended in live births in the US insured through Medicaid from 2000 to 2018
  • Exposures
    • Medication type
      • Buprenorphine
      • Methadone
    • Medication exposure time
      • Early pregnancy: Through 19 weeks
      • Late pregnancy: 20 weeks through day before delivery
      • 30 days before delivery
  • Study design
    • Adjusted Risk ratio (aRR) for outcomes were adjusted for confounders with the use of propensity score overlap weights
  • Primary outcomes
    • Neonatal and maternal outcomes

RESULTS:

  • 2,548,372 pregnancies
    • Early pregnancy exposures
      • Buprenorphine: 10704 | Methadone: 4387
    • Late pregnancy exposures
      • Buprenorphine: 11272 | Methadone: 5056
    • Last 30 days exposures
      • Buprenorphine: 9976 | Methadone: 4587
  • Neonatal abstinence syndrome occurred in fewer infants in the early exposure buprenorphine group
    • Buprenorphine: 52.0%
    • Methadone: 69.2%
    • aRR 0.73 (95% CI, 0.71 to 0.75)
  • Risk for the following adverse outcomes were also significantly reduced in the buprenorphine group
    • Preterm birth
      • Buprenorphine: 14.4%
      • Methadone: 24.9%
      • aRR 0.58 (95% CI, 0.53 to 0.62)
    • Small for gestational age
      • Buprenorphine: 12.1%
      • Methadone: 15.3%
      • aRR 0.72 (95% CI, 0.66 to 0.80)
    • Low birth weight
      • Buprenorphine: 8.3%
      • Methadone: 14.9%
      • aRR 0.56 (95% CI, 0.50 to 0.63)
  • There were no differences in
    • Cesarean deliveries
      • Buprenorphine: 33.6%
      • Methadone: 33.1%
      • aRR 1.02 (95% CI, 0.97 to 1.08)
    • Severe maternal complications
      • Buprenorphine: 3.3%
      • Methadone: 3.5%
      • aRR 0.91 (95% CI, 0.74 to 1.13)
  • Results of exposure in late pregnancy were consistent with results of exposure in early pregnancy

CONCLUSION:

  • Use of buprenorphine in pregnancy was associated with a reduced risk of adverse neonatal outcomes, compared to methadone use
  • Adverse maternal outcomes were similar for buprenorphine and methadone
  • The authors state

Any opioid agonist therapy is recommended over untreated opioid use disorder during pregnancy, because untreated persons have greater incidence of adverse outcomes owing to withdrawal, return to opioid use, overdose, intravenous drug use, and inadequacy of prenatal care

Results of our study using a large, national database of Medicaid beneficiaries showed that buprenorphine treatment for opioid use disorder during pregnancy was associated with more favorable neonatal outcomes than methadone treatment 

Learn More – Primary Sources:

Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure (MOTHER Trial)

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Can Pain Following Gyn Oncology Surgery Be Managed with a Very Restrictive Opioid Protocol?
The Opioid Crisis: Can Using A Decision Aid Decrease Opioid Prescribing Following Hysterectomy?
Are the Number of Opioid Pills Prescribed Related to Consumption in Post-Op Patients?
Is Opioid Exposure During First Trimester Linked to Increased Risk of Congenital Malformations?
Opioids in the First Trimester: Is There a Risk for Congenital Malformations?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site