Reducing the dose of buprenorphine during pregnancy is not associated with adverse outcomes, and lower doses of the opioid maintenance therapy at the time of delivery are in fact linked to benefits including reductions in the length of hospital stay and improved neonatal outcomes.
A study presented here at The Pregnancy Meeting, the Annual Meeting of the Society for Maternal-Fetal Medicine (SMFM) showed that neonates born to mothers who reduce their buprenorphine dose in the latter half of pregnancy required less opiates for the treatment of neonatal abstinence syndrome (NAS).
While buprenorphine for opioid maintenance therapy in pregnancy has been shown to be associated with improved neonatal outcomes compared with methadone, evidence on the effects of dose changes and lower doses has been lacking.
In the first of 2 studies looking at the issues, Lauren A. Miller, MD, University of Rochester Strong Memorial Hospital, Rochester, New Yor, and colleagues evaluated 80 mother-infant pairs with antenatal exposure to prescribed buprenorphine, with or without naloxone, from 2011 to 2017.
All of the mothers had net dose changes in buprenorphine between the second trimester and delivery. The dose changes ranged from a reduction of 18 mg to an increase of 10 mg, with 17 women having decreases (average reduction of 7 mg; median delivery dose 6 mg), 43 remaining on a stable dose (median delivery dose 16 mg), and 20 women increasing their dose (average increase of 4 mg, median delivery dose 15 mg).
Absolute dose change was significantly correlated with the reductions in the length of NAS treatment (P = .04) and amount of opiate needed to treat NAS (P = .05) compared with the stable-dose and increased-dose groups.
In addition, the reduced need for opiates to treat NAS continued after controlling for maternal dose of buprenorphine at the time of delivery (P< .05).
“At any given delivery dose, neonates who were exposed to an in-utero dose reduction had improved outcomes,” the noted.
For the second study, mother-infant pairs were divided according to buprenorphine dose at the time of delivery and categorised as low-dose (0-10 mg; n = 42), medium-dose (11-20 mg; n = 54), and high-dose (>20 mg; n = 13).
Results showed that the low- and medium-dose groups each had significantly shorter length of hospital stay (11.5 days and 13.5 days, respectively) compared with the high-dose cohort (19 days; P = .02), as well as lower rates of the need for NAS treatment (50% and 63% vs 100%; P = .002).
“Our data shows a significant dose-response relationship between buprenorphine dose at delivery and neonatal outcomes,” the authors concluded. “In this opioid epidemic, these new findings have important implications for management, counselling, and reducing the economic burden of neonatal abstinence syndrome.”