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Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study.

Abstract

OBJECTIVE

To compare maternal and fetal outcomes among dyads prescribed buprenorphine and naloxone or buprenorphine during pregnancy.

METHODS

Retrospective cohort study of patients with opioid use disorder obtaining care in a comprehensive, perinatal program. Patients utilized medication for opioid use disorder: a buprenorphine and naloxone combination product or buprenorphine monotherapy. The primary outcome was neonatal abstinence syndrome requiring treatment. Maternal secondary outcomes included: negative urine drug screen at delivery, obstetrical care attendance, primary cesarean delivery, and preterm delivery. Neonatal secondary outcomes included neonatal biometry, admission to neonatal intensive care, appropriate findings on cord toxicology, and length of stay. Univariate analyses included Chi square, Fisher exact, t-, or Mann-Whitney tests, as appropriate. Multivariate binary logistic regressions examined the association of type of buprenorphine product with diagnosis of neonatal abstinence syndrome requiring treatment and adjusted for variables significantly different in between-group comparisons and correlates of treatments and the primary outcome.

RESULTS

The rate of neonatal abstinence syndrome was significantly higher (P = 0.007) among infants exposed in utero to buprenorphine versus buprenorphine and naloxone: 59/108 (54.6%) versus 30/85 (35.3%), respectively. The combined product, relative to the monoproduct, was associated with lower odds of neonatal abstinence syndrome: odds ratio (OR) = 0.453 (95% confidence interval [CI] 0.253-0.813; P = 0.008). Adjusting for dose of buprenorphine product at delivery, year of expected delivery, type of prescriber, diagnosis of hepatitis C, and preterm delivery negated these results: adjusted OR = 0.627 (95% CI 0.309-1.275). Secondary outcomes were similar.

CONCLUSION

Compared with buprenorphine monotherapy, the combined buprenorphine and naloxone product was an acceptable alternative pharmacologic treatment for opioid use disorder during pregnancy.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC (NM, MR, MG, CCC); Department of Research, UNC Health Sciences at MAHEC, Asheville, NC (SLG); Department of Obstetrics and Gynecology, UNC-Chapel Hill School of Medicine, Chapel Hill, NC (CCC, SLG); OB/GYN Residency Program, Mountain Area Health Education Center, Asheville, NC (KL, BS).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31567599

Citation

Mullins, Nathan, et al. "Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: a Cohort Study." Journal of Addiction Medicine, 2019.
Mullins N, Galvin SL, Ramage M, et al. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2019.
Mullins, N., Galvin, S. L., Ramage, M., Gannon, M., Lorenz, K., Sager, B., & Coulson, C. C. (2019). Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000562.
Mullins N, et al. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: a Cohort Study. J Addict Med. 2019 Sep 17; PubMed PMID: 31567599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. AU - Mullins,Nathan, AU - Galvin,Shelley L, AU - Ramage,Melinda, AU - Gannon,Marie, AU - Lorenz,Kathleen, AU - Sager,Brent, AU - Coulson,Carol C, Y1 - 2019/09/17/ PY - 2019/10/1/entrez PY - 2019/10/1/pubmed PY - 2019/10/1/medline JF - Journal of addiction medicine JO - J Addict Med N2 - OBJECTIVE: To compare maternal and fetal outcomes among dyads prescribed buprenorphine and naloxone or buprenorphine during pregnancy. METHODS: Retrospective cohort study of patients with opioid use disorder obtaining care in a comprehensive, perinatal program. Patients utilized medication for opioid use disorder: a buprenorphine and naloxone combination product or buprenorphine monotherapy. The primary outcome was neonatal abstinence syndrome requiring treatment. Maternal secondary outcomes included: negative urine drug screen at delivery, obstetrical care attendance, primary cesarean delivery, and preterm delivery. Neonatal secondary outcomes included neonatal biometry, admission to neonatal intensive care, appropriate findings on cord toxicology, and length of stay. Univariate analyses included Chi square, Fisher exact, t-, or Mann-Whitney tests, as appropriate. Multivariate binary logistic regressions examined the association of type of buprenorphine product with diagnosis of neonatal abstinence syndrome requiring treatment and adjusted for variables significantly different in between-group comparisons and correlates of treatments and the primary outcome. RESULTS: The rate of neonatal abstinence syndrome was significantly higher (P = 0.007) among infants exposed in utero to buprenorphine versus buprenorphine and naloxone: 59/108 (54.6%) versus 30/85 (35.3%), respectively. The combined product, relative to the monoproduct, was associated with lower odds of neonatal abstinence syndrome: odds ratio (OR) = 0.453 (95% confidence interval [CI] 0.253-0.813; P = 0.008). Adjusting for dose of buprenorphine product at delivery, year of expected delivery, type of prescriber, diagnosis of hepatitis C, and preterm delivery negated these results: adjusted OR = 0.627 (95% CI 0.309-1.275). Secondary outcomes were similar. CONCLUSION: Compared with buprenorphine monotherapy, the combined buprenorphine and naloxone product was an acceptable alternative pharmacologic treatment for opioid use disorder during pregnancy. SN - 1935-3227 UR - https://www.unboundmedicine.com/medline/citation/31567599/Buprenorphine_and_Naloxone_Versus_Buprenorphine_for_Opioid_Use_Disorder_in_Pregnancy:_A_Cohort_Study L2 - http://dx.doi.org/10.1097/ADM.0000000000000562 DB - PRIME DP - Unbound Medicine ER -