title: Buprenorphine and naloxone compared with methadone treatment in pregnancy.
abstract: OBJECTIVE
  To compare neonatal abstinence syndrome prevalence and characteristics among neonates born to women prescribed buprenorphine and naloxone compared with methadone during pregnancy.
  
  
  METHODS
  Retrospective cohort analysis of mother-neonate dyads treated with either buprenorphine and naloxone or methadone during pregnancy. Primary neonatal outcomes included diagnosis of neonatal abstinence syndrome, neonatal abstinence syndrome peak scores, total amount of morphine used to treat neonatal abstinence syndrome (mg), and duration of treatment for neonatal abstinence syndrome (days). Secondary outcomes included head circumference, birth weight, length, preterm birth, neonatal intensive care unit admission, Apgar scores, and overall length of hospitalization.
  
  
  RESULTS
  From January 1, 2011, to November 30, 2013, we identified 62 mother-neonate dyads, 31 treated with methadone and 31 treated with buprenorphine and naloxone. Sixteen neonates (51.6%) in the methadone group were diagnosed with neonatal abstinence syndrome compared with eight (25.1%) in the buprenorphine and naloxone group (adjusted odds ratio 2.55, 95% confidence interval [CI] 1.31-4.98, P = .01). The buprenorphine and naloxone-exposed neonates had lower peak neonatal abstinence syndrome scores (9.0 ± 4.4 compared with 10.7 ± 3.7, multivariate-adjusted mean difference = -2.77, 95% CI -4.99 to -0.56, P = .02) and shorter overall hospitalization (5.6 ± 5.0 compared with 9.8 ± 7.4 days, multivariate-adjusted mean difference = -3.90, 95% CI, -7.13 to -0.67, P = .02). We found no other differences in primary or secondary outcomes.
  
  
  CONCLUSIONS
  In a cohort of pregnant patients treated with either methadone or buprenorphine and naloxone in pregnancy, newborns exposed to maternal buprenorphine and naloxone had less frequent neonatal abstinence syndrome. Additionally, neonates exposed to buprenorphine and naloxone had shorter overall hospitalization lengths.
authors.affiliation: Departments of Obstetrics and Gynecology and Pediatrics, University of North Carolina School of Medicine, and the Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Wiegand
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
authors.forename: Hendree
authors.initials: H
authors.lastname: Jones
authors.forename: Carl
authors.initials: C
authors.lastname: Seashore
authors.forename: John
authors.initials: J
authors.lastname: Thorp
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects; D009270:Naloxone / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000009:adverse effects*; D009294:Narcotics / Q000009:adverse effects; D009357:Neonatal Abstinence Syndrome / Q000517:prevention & control*; D058850:Opiate Substitution Treatment / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone