Neonatal and maternal effects of buprenorphine in the treatment of opioid-maintained pregnant women

Introduction:  Infants born to women using illicit drugs can experience neonatal abstinence syndrome (NAS). Methadone has been the standard of treatment for opioid addiction during pregnancy, but recent studies have shown buprenorphine is effective and decreases NAS.

Objectives:  To determine the neonatal and maternal effects of buprenorphine in opioid-maintained obstetric patients enrolled in the Women and Infant Substance abuse Help (WISH) clinic.

Study Design:  This is phase 1 of data collection in a retrospective cohort study.

Methods:  WISH patients who were prescribed buprenorphine and delivered within the SSM health system from 9/1/2014 to 11/4/2015 were included. The chart review included various maternal demographics and infant outcomes.

Results:  A total of 22 patients met eligibility with a mean age of 27.8 years. Six patients were treated for a psychiatric condition and 19 used tobacco. Patients attended on average 8.5 clinic visits and received buprenorphine for 97.3 days. At delivery, 68% of maternal urine drug screens were negative. On average, the mean gestational age at delivery was 38 weeks 3 days (range 34 weeks 6 days, 41 weeks 1 day). Peak NAS scores were 9.05 (range 2, 15) and occurred 46.9 hours after delivery. Six infants (27%) were treated for NAS. Excluding one outlier, the average total amount of morphine required was 2.46 mg, with a peak dose of 0.056 mg. No other medications were required for NAS treatment. For WISH infants, observation is 4 to 7 days. Length of stay (LOS) was 7.71 days, with an average of 2.66 days in the well-infant nursery and 5.05 days in the neonatal intensive care unit.

Conclusions: Treatment of opioid-maintained women with buprenorphine in this clinic showed comparable results to previously published literature. There were less infants treated for NAS, a shorter LOS, lower peak NAS scores, and a lower total morphine dose was used.