title: Fetal assessment before and after dosing with buprenorphine or methadone.
abstract: OBJECTIVE
  To determine pre- and post-dosing effects of prenatal methadone compared to buprenorphine on fetal wellbeing.
  
  
  METHODS
  A secondary analysis of data derived from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a double-blind, double-dummy, randomized clinical trial.
  
  
  METHODS
  Six United States sites and one European site that provided comprehensive opioid-dependence treatment to pregnant women.
  
  
  METHODS
  Eighty-one of the 131 opioid-dependent pregnant women completing the MOTHER clinical trial, assessed between 31 and 33 weeks of gestation.
  
  
  METHODS
  Two fetal assessments were conducted, once before and once after study medication dosing. Measures included mean fetal heart rate (FHR), number of FHR accelerations, FHR reactivity in the fetal non-stress test (NST) and biophysical profile (BPP) score.
  
  
  RESULTS
  Significant group differences were found for number of FHR accelerations, non-reactive NST and BPP scores (all Ps < 0.05). There were no significant group differences before time of dosing. Significant decreases (all Ps < 0.05) occurred from pre- to post-dose assessment for mean FHR, FHR accelerations, reactive NST and fetal movement. The decrease in accelerations and reactive NST were significant only for fetuses in the methadone group, and this resulted in a significantly lower likelihood of a reactive NST compared to fetuses in the buprenorphine group.
  
  
  CONCLUSIONS
  Buprenorphine compared with methadone appears to result in less suppression of mean fetal heart rate, fetal heart rate reactivity and the biophysical profile score after medication dosing and these findings provide support for the relative safety of buprenorphine when fetal indices are considered as part of the complete risk-benefit ratio.
authors.affiliation: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA. Amy_Salisbury@Brown.edu
authors.forename: Amy L
authors.initials: AL
authors.lastname: Salisbury
authors.forename: Mara G
authors.initials: MG
authors.lastname: Coyle
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
authors.forename: Peter R
authors.initials: PR
authors.lastname: Martin
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stine
authors.forename: Karol
authors.initials: K
authors.lastname: Kaltenbach
authors.forename: Manfred
authors.initials: M
authors.lastname: Weninger
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use*; D055592:Biophysical Phenomena / Q000187:drug effects; D002047:Buprenorphine / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D005324:Fetal Movement / Q000187:drug effects; D005333:Fetus / Q000187:drug effects; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000494:pharmacology / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000534:rehabilitation; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone