Buprenorphine treatment was linked with better outcomes for mother and infant, according to a study of pregnant individuals with opioid use disorder (OUD).

Among 14,463 maternal-infant dyads, there was a statistically significant lower rate of adverse pregnancy outcomes among those who were treated with buprenorphine compared to those who did not receive treatment (25.4% vs 30.8%, P<0.001), reported Stephen Patrick, MD, MPH, MS, of Emory University in Atlanta, and colleagues.

In adjusted analyses, dyads with buprenorphine treatment had a 5.1 percentage point (95% CI 3.5-6.7) lower probability of any adverse outcomes, they stated in JAMA Health Forum. The data were simultaneously presented at the Pediatric Academic Societies annual meeting in Honolulu.

Specifically, those with treatment had a 1.2 percentage point (95% CI 0.4-2.1) lower probability of severe maternal morbidity (SMM), a 1.7 percentage point (95% CI 0.4-2.9) lower probability of NICU admission, and a 5.3 percentage point (95% CI 4.0-6.6) lower probability of preterm birth, they added.

To date, research on buprenorphine’s use in pregnancy has focused on comparison of its clinical outcomes with those of methadone, Patrick’s group stated, and research comparing treatment with no treatment has been limited to methadone analyses in the 1970s.

“Furthermore, more recent secondary data analyses combined different types of pharmacotherapy for OUD with different mechanisms and have not accounted for treatment selection bias (ie, bias among groups that leads to treatment receipt) or evaluated maternal outcomes (eg, SMM) alongside matched infant outcomes,” they said. “Nationwide, at least 50% of pregnant individuals with OUD do not receive treatment. Consequently, determining if buprenorphine in pregnancy improves pregnancy outcomes compared to no treatment is a highly relevant public health question that could inform public health programs and policy.”

Of the current study, Patrick told MedPage Today that, “one of the things that is striking…is this five percentage point reduction in preterm birth.”

He explained that much of the conversation surrounding treatment of OUD during pregnancy has focused on the benefit for moms, reduction in overdose. Additionally, there has been research focused on the potential for neonatal opioid withdrawal syndrome (NOWS) following treatment, he said. Meanwhile, reduction in preterm birth often gets missed.

“Treatment for mom helps babies too,” Patrick said. “And this is really that focus on moms and babies together. It’s effective. And so this really should be a call for us to increase our efforts to try to get people into treatment as early as possible.”

Jeffrey Ecker, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, noted that the study adds to the existing body of work on buprenorphine in pregnancy versus no treatment, but closes an information gap in the data.

“If we want healthy people, healthy mothers, healthy newborns, we will screen for opioid use disorder and then treat when appropriate,” said Ecker, who was not involved in the study.

Overall, Patrick and colleagues found that the number needed to treat to prevent one adverse outcome was 20.

Additional findings of the retrospective, cohort study were that maternal-infant dyads with buprenorphine treatment had a lower rate of SMM events (5.4% vs 6.9%, P<0.001), preterm births (14.1% vs 20.0%, P<0.001), and NICU admissions (15.2% vs 17.2%, P=0.001).

However, the rate of infants with NOWS diagnoses was higher in the treated group versus the untreated group (51.7% vs 32.4%, P<0.001). And there was no statistically significant difference in the rates of ICU admission, maternal death, or infant death.

In supplementary analyses, among pregnant individuals treated with buprenorphine, “timing, days treated, or dose did not change the associations with treatment receipt and pregnancy outcomes, nor did limiting to only those with an OUD diagnosis in pregnancy,” the authors reported.

The study included maternal-infant dyads continuously enrolled in the Tennessee Medicaid program from 20 weeks’ estimated gestational age to 6 weeks post-partum between 2010 and 2021. Median maternal age was 27.

Slightly more than half of the dyads received buprenorphine treatment. Among those, 1.1% identified as Hispanic, 2.1% as Black, 94.7% as white, and 2.1% as another race. Among those not treated with buprenorphine, those percentages came in at 1.7%, 10.2%, 85.5%, and 2.6%, respectively.

Other demographic and pregnancy-specific characteristics, including a lack of early prenatal care and attainment of a high school degree or less, were similar between groups, as was the presence of comorbid substance use, such as smoking, which was high across the board.

Study limitations included the possibility of residual confounding despite the use of multiple data sources and propensity scores with overlap weighting, and potential misclassification bias in primary data sources. Also, filled prescription records for buprenorphine were used rather than actual observed medication administration, according to the authors.

Additionally, the results may not be generalizable beyond Tennessee or to non-Medicaid populations, they added. Finally, diagnoses, such as mental health diagnoses, may have occurred pre-pregnancy and were not detected during the study period.

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