Buprenorphine-naloxone combo appears safe for treating opioid use disorder in pregnancy


January 18, 2023

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Source/Disclosure

Disclosure:
Kanervo does not report related financial disclosures. This research was supported by the Pediatric Research Foundation and the Paivicki and Sakari Solberg Foundation.


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Women receiving buprenorphine-naloxone therapy for the treatment of opioid use disorder during pregnancy showed similar results with respect to maternal and neonatal health compared with buprenorphine therapy alone.

“Our results provide a promising reference that combined buprenorphine and naloxone therapy may be an oral opioid maintenance therapy during pregnancy.” Minna M. Kanervo A postdoctoral fellow at the University of Helsinki told Helio. “Like previous studies, our findings suggest that stable-dose alternative therapy is preferable to weight loss during pregnancy because the risk of substance abuse increases with decreasing dosage. And second, because the dosage appears to be independent of the newborn’s need for medication, which can lead to withdrawal symptoms.”

Combination therapy with buprenorphine and naloxone ‘appears to be safe’ for mothers and newborns in the treatment of opioid use disorders. Source: Adobe Stock

Cohort characterization

Kanervo et al. followed 69 pregnant women who received the same opioid maintenance therapy from conception to delivery at the Helsinki University Women’s Hospital from 2011 to 2018. She had 15 pairs in the naloxone group, the buprenorphine only group, and 15 pairs in the methadone group.

Most women reported smoking before (97%) and during pregnancy (93%), and approximately 20% reported using alcohol during pregnancy. About half of the study population were self-reported or tested positive for illicit drug use during pregnancy, which was more common in the methadone group than in the buprenorphine group (P. = .001).

Minna M. Canervo

Go to M. Kinervo

“As a pediatrician, I am concerned about this not only because of fetal drug exposure, but also because of the circumstances in which the child lives if the mother or parents continue to use substances after the child is born. increase.

Compared to women in either buprenorphine group, women in the methadone group more commonly had psychiatric complications (.P. = .025) and active hepatitis C virus infection (P. = .013).

pregnancy outcome

Compared with the general population of pregnant Finnish women, women on opioid maintenance therapy were similar in age but less likely to have their first child (41% vs 16%).

In total, there were 53 (79%) spontaneous vaginal deliveries and 13 (19%) caesarean sections in the study cohort. Complications during pregnancy occurred at similar rates compared to the general population of Finnish pregnant women, and deliveries went “almost without problems,” according to the researchers.

All but 3 infants (96%) were born at term and all had a 5-minute Apgar score of at least 5. One infant (3%) in the buprenorphine-naloxone group and two of her (13%) in the methadone group had scores of 5 or 6.

Infants in the study cohort were smaller than those in the general population, with 15 (22%) born small for gestational age. Infants in the methadone group were the smallest in the cohort, but the differences between treatments were not statistically significant.

Congenital malformations were mild and uncommon, with no significant differences between groups.

The need for neonatal opioid withdrawal syndrome treatment was lowest in the buprenorphine-naloxone group (51%) and highest in the methadone group (87%). Compared with infants in either buprenorphine group, infants in the methadone group were more likely to require treatment for neonatal opioid withdrawal syndrome (56% vs. 87%; P. = .029).

An analysis of neonates exposed to illicit drugs prenatally showed that neonates in the methadone group were more likely to require treatment for neonatal opioid withdrawal syndrome (P. = .048).

“Buprenorphine-naloxone has a lower potential for abuse than buprenorphine or methadone, so it could be a treatment option during pregnancy, but larger studies are needed to confirm the results,” Kanervo said in Healio. told to



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