Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review

Addiction. 2012 Nov;107 Suppl 1(0 1):5-27. doi: 10.1111/j.1360-0443.2012.04035.x.

Abstract

Aims: This paper reviews the published literature regarding outcomes following maternal treatment with buprenorphine in five areas: maternal efficacy, fetal effects, neonatal effects, effects on breast milk and longer-term developmental effects.

Methods: Within each outcome area, findings are summarized first for the three randomized clinical trials and then for the 44 non-randomized studies (i.e. prospective studies, case reports and series and retrospective chart reviews), only 28 of which involve independent samples.

Results: Results indicate that maternal treatment with buprenorphine has comparable efficacy to methadone, although difficulties may exist with current buprenorphine induction methods. The available fetal data suggest buprenorphine results in less physiological suppression of fetal heart rate and movements than methadone. Regarding neonatal effects, perhaps the single definitive conclusion is that prenatal buprenorphine treatment results in a clinically significant less severe neonatal abstinence syndrome (NAS) than treatment with methadone. The limited research suggests that, like methadone, buprenorphine is compatible with breastfeeding. Data available thus far suggest that there are no deleterious effects of in utero buprenorphine exposure on infant development.

Conclusions: While buprenorphine produces a less severe neonatal abstinence syndrome than methadone, both methadone and buprenorphine are important parts of a complete comprehensive treatment approach for opioid-dependent pregnant women.

Trial registration: ClinicalTrials.gov NCT00271219.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Buprenorphine / adverse effects
  • Buprenorphine / pharmacology
  • Buprenorphine / therapeutic use*
  • Child Development / drug effects
  • Female
  • Fetus / drug effects
  • Humans
  • Infant, Newborn
  • Length of Stay
  • Methadone / therapeutic use
  • Milk, Human / chemistry
  • Morphine / therapeutic use
  • Narcotic Antagonists / adverse effects
  • Narcotic Antagonists / pharmacology
  • Narcotic Antagonists / therapeutic use*
  • Neonatal Abstinence Syndrome / drug therapy
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / urine
  • Pain Management / methods
  • Patient Dropouts
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Prenatal Exposure Delayed Effects / therapy
  • Randomized Controlled Trials as Topic
  • Substance Abuse Detection*
  • Treatment Outcome

Substances

  • Narcotic Antagonists
  • Buprenorphine
  • Morphine
  • Methadone

Associated data

  • ClinicalTrials.gov/NCT00271219