Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Gregory Goshgarian; Rasha Jawad; Laura O'Brien; Robert Muterspaugh; Dimitrios Zikos; Sudhakar Ezhuthachan; Christine Newman; Chaur-Dong Hsu; Beth Bailey; Neli Ragina

doi:10.7759/cureus.27790

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Cureus. 2022 Aug 8;14(8):e27790. doi: 10.7759/cureus.27790. eCollection 2022 Aug.

Affiliations

¹ College of Medicine, Central Michigan University College of Medicine, Saginaw, USA.
² College of Health Professions, Central Michigan University, Mount Pleasant, USA.
³ Division of Neonatal-Perinatal Medicine, Henry Ford Health, Detroit, USA.
⁴ Department of Obstetrics and Gynecology, University of Arizona, Tucson, USA.
⁵ College of Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA.

Abstract

Background Maternal opioid exposure during pregnancy has various effects on neonatal health. Buprenorphine/naloxone and methadone are examples of medications for opioid use disorder (MOUD) used for the treatment of opioid use disorder (OUD). Research comparing the impacts of these MOUD modalities on neonatal outcomes when used to treat pregnant people with OUD remains limited. We evaluated the differences in outcomes between neonates with in-utero exposure to buprenorphine/naloxone versus methadone. Methodology We performed a retrospective cohort chart review between October 15, 2008, and October 15, 2019, evaluating mother/neonate dyads at two medical centers in Michigan. The charts of female patients, aged 18+, with OUD and buprenorphine/naloxone or methadone treatment, were examined. The charts of the corresponding neonates were also examined. Multiple regression analysis was performed. Results In total, 343 mother/infant dyads were included: 99 patients were treated with buprenorphine/naloxone and 232 patients were treated with methadone. The buprenorphine/naloxone group had significant differences in maternal age, hepatitis status, asthma, gestational age in weeks, neonatal intensive care unit (NICU) length of stay (LOS), neonatal opioid withdrawal syndrome (NOWS) peak score, birth head circumference, and birth weight compared to the methadone group at baseline. Adjusted multivariable regression analysis demonstrated neonates with exposure to buprenorphine/naloxone had a NOWS peak score 3.079 points less (95% confidence interval (CI): -4.525, 1.633; p = 0.001) and NICU LOS 8.955 days less (95% CI: -14.399, -3.511; p = 0.001) than neonates exposed to methadone. Conclusions Neonates with in-utero exposure to buprenorphine/naloxone had significantly lower NOWS scores and shorter NICU LOS compared to neonates with in-utero exposure to methadone. These findings demonstrate that buprenorphine/naloxone is potentially a more favorable treatment for the reduction in metrics representing adverse neonatal outcomes in pregnant people with OUD than methadone.

Keywords: buprenorphine and naloxone; medication for opioid use disorder (moud); methadone; neonatal health outcomes; neonatal opioid withdrawal syndrome; opioid use disorder (oud).

Grants and funding

GG is reporting that he received funding from the Blue Cross and Blue Shield Foundation (BCBSM) under its Student Award Program (002836.SAP) for this work. In addition, GG, LO, and RM received funding from Central Michigan University College of Medicine (CMUCOM) under the Medical Student Summer Scholar Program for this work. Both funding bodies (BCBSM and CMUCOM) had no involvement or impact on the development of this research, and the authors do not have any other involvement with the funding bodies.