Few population-based data exist on birth outcomes in women
who received opioid maintenance treatment during pregnancy. We therefore
examined adverse birth outcomes in women exposed to methadone or buprenorphine
during pregnancy and the risk of neonatal abstinence syndrome (NAS) among
neonates exposed to buprenorphine, methadone, and/or heroin in utero.
This study included all female Danish residents with a live
birth or a stillbirth from 1997 to 2011. We identified the study population,
use of opioids and opioid substitution treatment, birth outcomes, and NAS
through medical registers. Birth outcomes included preterm birth (born before
38th gestational week), low-birth weight (LBW) (<2,500 g, restricted to term
births), small for gestational age (SGA) (weight <2 standard deviations from
the sex- and gestational-week-specific mean), congenital malformations, and
stillbirths. We used log-binomial regression to estimate the prevalence ratio
(PR) for birth outcomes.
Among 950,172 pregnancies in a total of 571,823 women, we
identified 557 pregnancies exposed to buprenorphine, methadone, and/or heroin
(167 to buprenorphine, 197 to methadone, 28 to self-reported heroin, and 165 to
combinations). Compared with nonexposed pregnancies, prenatal opioid use was
associated with greater prevalence of preterm birth, LBW among infants born at term, and being SGA. Restricting the
analyses to women who smoked slightly lowered these estimates. The prevalence
of congenital malformations was 8.3% in opioid-exposed women compared with 4.2%
in nonexposed women. The risk of NAS ranged from
7% in neonates exposed to buprenorphine only to 55% in neonates exposed to
methadone only or to opioid combinations.
The maternal use of buprenorphine and methadone during
pregnancy was associated with increased prevalence of adverse birth outcomes,
and this increase could only be explained to a smaller extent by increased
prevalence of smoking. The risk of NAS was eight-fold higher in methadone-exposed
neonates than that in buprenorphine-exposed neonates, but this difference may
at least partly be explained by differences in underlying indications
(analgesic versus opioid maintenance treatment) between the two groups.
Full article
at:
Department of
Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University
Hospital, Aarhus, Denmark.
Email: kd.ua.nilc@nm
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment