Opioid Use Disorder Medication May Help Pregnant Women

Elizabeth Krans, MD, MSc

Use of opioid use disorder medication (MOUD) during pregnancy can likely help with optimizing maternal and perinatal outcomes, according to findings from a new study.

The team, led by Elizabeth Krans, MD, MSc, University of Pittsburg, analyzed a total of 13,320 pregnancies among 10,741 women with opioid use disorder.

“Despite MOUD’s effectiveness, the unique circumstances of pregnancy including the effect of opioid exposure on neonatal outcomes such as neonatal abstinence syndrome (NAS) have contributed to an evolving debate over the risks and benefits of MOUD use during pregnancy,” Krans and colleagues explain.

The Study

As such, their retrospective cohort analysis sought to examine outcomes during and 12 months following delivery. These outcomes included overdose, postpartum MOUD continuation, preterm birth (defined as <37 weeks gestation), low birth weight (<2500 g at ≥37 weeks), and neonatal abstinence syndrome.

They further assessed such outcomes according to length of exposure, quantified in weeks.

Data was collected using healthcare claims from the Pennsylvania Department of Health and Human Services Medicaid program. All patients were female aged 15-44 years who had a live birth between January 1, 2009-September 30, 2017 as well as a diagnosis of opioid use disorder according to ICD-10 codes.

The investigators excluded any patients in remission for opioid use disorder.

Overall, the team followed the patients 280 days prior to delivery plus nearly 3 months postpartum. Available follow-up data at 3 months was then assessed.

As treatment during pregnancy course, patients received methadone only, buprenorphine only, or both methadone and buprenorphine.

The investigators used log-linear regression to model the association between duration of MOUD use in pregnancy; logistic regression was used for all other outcomes.

Results

Overall, a total of 306 (2.3%) pregnancies were complicated by an overdose.

Furthermore, 1753 (13.2%) led to preterm births and 6787 (50.9%) proceeded with MOUD following delivery.

Even more, 874 infants (7.6%) were considered low birthweight and 7706 (57.9%) were diagnosed with NAS.

“As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS, and a decline in term low birthweight,” Krans and colleagues wrote.

They noted that each additional week of MOUD use decreased the adjusted odds of overdose by 2% (odds ratio [OR], 0.98; 95% CI, 0.97-0.99).

The odds for preterm birth decreased by 1% (OR, 0.99; 95% CI, 0.99-1.00, postpartum MOUD continuation increased by 95% (OR, 0.98; 95% CI, 0.97-0.99), and NAS increased by 41% (OR, 1.41; 95% CI 1.35-1. 47).

And finally, there were no differences in odds of low birthweight at birth; nevertheless, there was a noted decline in rate associated with a longer duration of MOUD.

“MOUD is a highly effective intervention that has been consistently shown to decrease the risk of overdose morbidity and mortality, improve social functioning and reduce 1 the risk of infectious disease acquisition in individuals with OUD,” the investigators wrote.

“Our findings provide evidence that in pregnancy, a longer duration of MOUD use may also result in improvements in pregnancy-associated outcomes including a reduced risk of preterm birth,” they continued.