title: Prenatal treatment for opioid dependency: observations from a large inner-city clinic.
abstract: The objective of this study was to review changes in the prevalence of opioid use disorder in pregnancy, and to describe the prenatal care and neonatal outcomes following the implementation of buprenorphine treatment at a large US obstetrical clinic during the on-going opioid epidemic.
  
  
  
  We conducted a retrospective cohort study of 310 women (332 pregnancies) with opioid use disorders and their neonates delivered between June 2006 and December 2010 at an obstetrical clinic in the US. Trends in patient volume, characteristics and outcomes by calendar year were assessed using the Cochran-Armitage test and linear regression.
  
  
  
  There was an almost two-fold increase in the volume of pregnant women treated annually from 2006 through 2010. Most women were treated with methadone (74%), with buprenorphine becoming more common over calendar time: 3.0% in 2006 to 41% in 2010. The mean dose of buprenorphine at delivery was: 11.4 mg in 2007, 14.1 mg in 2008, 14.1 mg in 2009, and 16.8 mg in 2010; an average increase of 2.1 mg year. There were no differences in mean methadone dose over time. From 2006 to 2010 there were increases in the prevalence of prescribed concomitant psychotropic medications and vaginal deliveries, and in the proportion of neonates treated pharmacologically for neonatal abstinence syndrome (NAS). NAS pharmacologic management also varied by calendar year with more use of neonatal morphine and clonidine in later years.
  
  
  
  The number of mother-infant pairs increased significantly from 2006 to 2010 and the clinical characteristics of these patients changed over time. Our experience reflects the rising increase in opioid use disorders in pregnancy and NAS, mandating the need for expansion of comprehensive prenatal care options for these women and their children.
authors.affiliation: Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA, 02118, USA. kelley.saia@bmc.org.
authors.forename: Kelley
authors.initials: K
authors.lastname: Saia
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.|Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bagley
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Elisha M
authors.initials: EM
authors.lastname: Wachman
authors.affiliation: Harvard Vanguard Medical Associates, Newton Wellesley Hospital, Newton, MA, USA.
authors.forename: Payal P
authors.initials: PP
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Marisa D
authors.initials: MD
authors.lastname: Nadas
authors.affiliation: Department of Surgery, Queen's University, Kingston, Canada.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Brogly
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009357:Neonatal Abstinence Syndrome / Q000517:prevention & control; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome