title: Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Hopkins University School of Medicine, Baltimore, MD, USA. hjones18@jhmi.edu
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
authors.forename: Andjela
authors.initials: A
authors.lastname: Baewert
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Arria
authors.forename: Karol
authors.initials: K
authors.lastname: Kaltenbach
authors.forename: Peter R
authors.initials: PR
authors.lastname: Martin
authors.forename: Mara G
authors.initials: MG
authors.lastname: Coyle
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stine
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fischer
mesh_terms: D002047:Buprenorphine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002657:Child Development / Q000187:drug effects; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008691:Methadone / Q000627:therapeutic use; D008895:Milk, Human / Q000737:chemistry; D009020:Morphine / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000652:urine; D059408:Pain Management / Q000379:methods; D010352:Patient Dropouts; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D015813:Substance Abuse Detection; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D009020:Morphine; D008691:Methadone