Methadone and buprenorphine for opioid dependence during pregnancy: a retrospective cohort study

Abstract

Objectives: To compare maternal characteristics, prenatal care, and newborn outcomes in a cohort of opioid-dependent pregnant women treated with methadone versus buprenorphine.

Methods: In a retrospective cohort study, 609 pregnant, opioid-dependent women were treated with methadone (n = 248) or buprenorphine (n = 361) between 2000 and 2012 at a single institution.

Results: Mothers treated with buprenorphine were more likely to start medication before or earlier in pregnancy, had longer gestation, and gave birth to larger infants. Newborns of buprenorphine- versus methadone-maintained mothers required treatment for neonatal abstinence significantly less often and for a shorter duration.

Conclusions: These data suggest pregnancy outcomes with buprenorphine to treat opioid dependence during pregnancy in clinical practice are as good and often better than outcomes with methadone. These results are consistent with efficacy data from randomized clinical trials and further support the use of buprenorphine for the treatment of opioid dependence during pregnancy.

Figures

Figure 1. Distribution of women treated with methadone or buprenorphine during pregnancy from August 2000–June 2012

A: Percent of women receiving opiate agonist therapy prior to pregnancy. The open bar represents women treated with methadone (n=95/225 (39.7%)); the hatched bar represents women treated with buprenorphine (n=196/342 (60.3%)). B: Gestational age at which opiate agonist therapy was initiated in women starting treatment during pregnancy; circles represent the mean gestational age (weeks) and lines represent the standard deviation. The open circle represents women treated with methadone (n=124: 18.9±9.1 weeks; n=6 missing data); the hatched circle represents women treated with buprenorphine (n=137: 15.9±8.1 weeks; n=9 missing data).