Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series.
OBJECTIVE
To compare the effects of fetal buprenorphine and methadone exposure during maintenance treatment of pregnant heroin dependent subjects.


METHODS
A population based comparison of consecutive, prospectively followed buprenorphine-exposed pregnancies in Stockholm County, Sweden, to retrospectively analyzed consecutive methadone-exposed pregnancies.


METHODS
All 47 pregnancies in 39 women with opiate dependence and buprenorphine maintenance treatment 2001-2006, and all 35 methadone-exposed pregnancies (26 women) 1982-2006 in Stockholm County.


METHODS
Intrauterine growth, birth outcome, malformations, neonatal adaptation, withdrawal syndrome and infant mortality.


RESULTS
Buprenorphine-exposed pregnancies resulted in 47 uneventful live births (2 twin pairs), 1 stillbirth (for which no explanation was found) and 1 miscarriage. The birth weight of the infants was normal. Neonatal abstinence syndrome (NAS) occurred in 19 cases (40.4%), the majority mild in nature and only 7 (14.9%) needing withdrawal treatment. Compared to 35 infants born after intrauterine methadone exposure at the same hospital since 1982 (77.8% of them exhibiting NAS and 52.8% needing withdrawal treatment), there were significant advantages with buprenorphine treatment: birth weight was higher, due to longer gestation. Incidence of NAS of any intensity, as well as incidence of NAS that required pharmacological treatment was lower, while length of hospital stay was shorter. When buprenorphine treatment started pre-conception, NAS at any level was significantly less frequent than in subjects with post-conception initiated treatment (7/27, 26%; 12/20, 60%, respectively).


CONCLUSIONS
Data from this non-randomized comparison suggest that buprenorphine may offer advantages for treatment of opiate dependence during pregnancy.
Kakko
Johan
J
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Heilig
Markus
M
Sarman
Ihsan
I
D001724:Birth Weight / Q000187:drug effects; D002047:Buprenorphine / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005317:Fetal Growth Retardation / Q000139:chemically induced* / Q000453:epidemiology; D006556:Heroin Dependence / Q000188:drug therapy / Q000534:rehabilitation; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000534:rehabilitation; D011256:Pregnancy Outcome / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology
D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone