Treating Pregnant and Parenting Women for Substance Use Disorders: Behavioral and Medication Strategies



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One of the goals of the MOTHER Study was to collect comprehensive data on maternal, fetal, and neonatal behavior that could be shared with the broader research community.

  • One of the goals of the MOTHER Study was to collect comprehensive data on maternal, fetal, and neonatal behavior that could be shared with the broader research community.
  • This broad availability of the MOTHER data has allowed MOTHER Principal Investigators and other researchers to ask a variety of questions about maternal, fetal, and neonatal issues related to maternal buprenorphine and/or methadone treatment. An Addiction Supplement issue will be published shortly reporting on these studies.
  • The following slides present findings from a number of these secondary outcome studies, including:
    • The extent to which 32-week fetal movement and cardiac measures differ between methadone and buprenorphine before and after dosing
    • Differences between buprenorphine- and methadone-maintained pregnant women in obstetrical and neonatal complications
    • Liver enzymes and their relationship to buprenorphine and methadone treatment, as well as HCV status
    • Differences in NAS signs between medications
    • Predicting treatment for neonatal abstinence syndrome
    • Neonatal neurobehavioral effects following buprenorphine v. methadone exposure

Incidence of NAS signs

  • Incidence of NAS signs
  • All neonates in each medication condition had at least one total NAS score greater than 0 at some point during the observation period.
  • Three individual signs were observed significantly more often in the buprenorphine than in the methadone condition: sneezing, loose stools, and nasal stuffiness.
  • There were no signs that were observed significantly more often in the methadone condition than in the buprenorphine condition.
  • *p ≤ .02
  • MOTHER: Buprenorphine v. Methadone NAS
  • Severity of NAS Signs
  • Methadone-exposed neonates had higher mean NAS total score, and higher mean scores for hyperactive. Moro reflex, disturbed tremors, undisturbed tremors, failure to thrive, and excessive irritability.
  • All ps ≤ 0.04
  • Heil et al., Addiction, 2012

Compared with methadone-exposed fetuses, buprenorphine-exposed fetuses have better indications of fetal well-being, including:

  • Compared with methadone-exposed fetuses, buprenorphine-exposed fetuses have better indications of fetal well-being, including:
  • In contrast, FM was most consistently suppressed in methadone-exposed fetuses at the later gestational age period.
  • Fetal Cardiac and Movement Parameters at 36 weeks
  • (N=11)
  • Primary Outcomes
  • Methadone n=6
  • Buprenorphine n=5
  • Z
  • Mean (SD)
  • FHR, bpm
  • 133.42 (7.89)
  • 134.58 (7.12)
  • -0.18
  • 4.43 (0.78)
  • 5.30 (2.16)
  • -0.37
  • Accelerations
  • 1.17 (1.17)
  • 2.80 (3.83)
  • 0.0
  • Motor activity
  • 3.58 (1.18)
  • 5.92 (2.95)
  • -2.01*
  • FM duration
  • 8.74 (2.71)
  • 21.53 (13.22)
  • -2.01*
  • 27.42 (13.97)
  • 18.88 (6.90)
  • -1.10
  • Jansson et al., Neurotoxicol Teratol, 2011
  • *p < .05
  • MOTHER: Buprenorphine v. Methadone Fetal 36 wks

Obstetrical and Neonatal Complications

  • Obstetrical and Neonatal Complications
  • Several studies have compared obstetrical outcomes for opioid-dependent pregnant women in maintenance treatment with buprenorphine or methadone.
    • Results have suggested that obstetrical outcomes are comparable between the two medications.
    • However, only two of these studies were randomized controlled trials, both with small sample sizes.
  • This study compared obstetrical and neonatal measures between buprenorphine and methadone for outcomes that were not presented in the MOTHER primary outcomes paper.
  • Holbrook et al., Addiction, 2012
  • MOTHER: OB Complications
  • There were few obstetrical and neonatal complications in the total sample, as well as in both the buprenorphine and methadone conditions.
  • Holbrook et al., Addiction, 2012
  • Methadone
  • Buprenorphine
  • Maternal methadone versus buprenorphine maintenance treatment was associated with:
  • p < .05
  • p < .05
  • MOTHER: Preterm Labor and Respiratory Distress
  • Holbrook et al., Addiction, 2012
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