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



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There was a significant difference between medication conditions in mean time to initiation of morphine treatment for those neonates treated for NAS, with the methadone condition requiring morphine treatment earlier than the buprenorphine condition.

  • There was a significant difference between medication conditions in mean time to initiation of morphine treatment for those neonates treated for NAS, with the methadone condition requiring morphine treatment earlier than the buprenorphine condition.
  • Methadone
  • (n = 41)
  • Buprenorphine
  • (n = 27)
  • p = .01
  • Gaalema et al., Drug Alc Depend 2013
  • Methadone Mean
  • Buprenorphine Mean
  • Neurobehavioral functioning improves during the first month of life for neonates exposed to opioid-agonist medication in utero (data not shown).
  • Relative to the methadone condition, the buprenorphine condition results in superior neurobehavioral functioning on several outcomes.
  • All ps < .04
  • Coyle et al., Addiction 2012

  • MOTHER provided the first RCT data to support the safety and efficacy of methadone.
  • Maternal outcomes are similar between medications.
  • Pain management and breastfeeding recommendations are similar between medications.
  • In terms of NAS severity, buprenorphine can be a front-line medication option for managing opioid-dependence for pregnant women who are new to treatment or maintained on buprenorphine pre-pregnancy.
  • NAS, its treatment and elucidating factors that exacerbate and minimize it, remains a significant clinical issue for prenatally opioid-exposed neonates.
  • Currently there is great variation in terms of medications and use of tools.
  • Summary: MOTHER Contributions
  • Buprenorphine
  • (n=47)
  • Methadone
  • (n=35)
  • p
  • Gestational age (weeks)
  • 39.5 ± 2.0
  • 38.6 ± 1.5
  • .06
  • Birth weight (g)
  • 3250 ± 528
  • 2941 ± 483
  • .008
  • Birth length (cm)
  • 48.4 ± 2.5
  • 47.6 ± 2.2
  • .12
  • Head circumference (cm)
  • 34.0 ± 1.4
  • 33.8 ± 1.5
  • ns
  • 3 (6.4)
  • 9 (25)
  • .03
  • Infants with birth weight ≤ −2 SD
  • 6 (12.8%)
  • 11 (30.6%)
  • ns
  • Infants with birth height/head circumference ratio ≤ − 2SD
  • 1 (2.1%)
  • 1 (2.8%)
  • ns
  • Measures of fetal growth
  • Kakko, Heilig, Sarman. Drug Alcohol Depend 2008
  • Buprenorphine v. Methadone
  • Buprenorphine
  • (n=47)
  • Methadone
  • (n=35)
  • p
  • Infants with any NAS
  • 19 (40.4%)
  • 28 (77.8%)
  • .0008
  • Infants treated for NAS
  • 7 (14.9%)
  • 19 (52.8%)
  • .0004
  • Total hospital stay (days)
  • 9.4 ± 8.4
  • 19.7 ± 18.8
  • .0009
  • Buprenorphine v. Methadone
  • Results are given as counts followed by percentages, or as means ± SD
  • Kakko, Heilig, Sarman. Drug Alcohol Depend 2008
  • 5
  • Meyer, Johnston, Crocker, Heil. J Addiction Medicine 2015
  • Methadone (n = 248)
  • Buprenorphine (n = 361)
  • M (SD) or
  • M (SD) or
  • Infant Characteristics
  • n
  • n (%)
  •  
  • n
  • n (%)
  • p
  • Male
  • 248
  • 111 (45%)
  • 361
  • 177 (49%)
  • .299
  • EGA at Delivery (weeks)
  • 248
  • 38.2 (2.5)
  • 361
  • 39.2 (2.2)
  • <.001
  • Preterm (EGA < 37 weeks)
  • 248
  • 43 (17%)
  • 361
  • 36 (10%)
  • <.001
  • Birthweight (g)
  • 248
  • 2899.7 (583.1)
  • 361
  • 3143.3 (578.9)
  • <.001
  • 248
  • -0.59 (.93)
  • 361
  • -46 (.98)
  • .089
  • < 5th percentile
  • 248
  • 32 (13%)
  • 361
  • 40 (11%)
  • .494
  • Head circumference (cm)
  • 209
  • 33.0 (2.0)
  • 279
  • 33.6 (2.1)
  • <.001
  • Standardized, z score
  • 209
  • -.50 (.80)
  • 279
  • -46 (.98)
  • .669
  • Treated for NAS
  • 245
  • 106 (42%)
  • 358
  • 82 (23%)
  • <.001
  • 106
  • 133 ± 83
  • 79
  • 83 ± 60
  • <.001
  • Length of Stay (EGA ≥ 37 weeks)
  • 205
  • 5.6 (2.8)
  • 325
  • 4.2 (12.6)
  • .107
  • Breast Milk at Discharge
  • 247
  • 156 (63%)
  • 358
  • 267 (75%)
  • .003
  • Discharged to Mother/Family
  • 248
  • 237 (96%)
  • 360
  • 351 (98%)
  • .189
  • Methadone and Buprenorphine: Outcomes
  • A random-effects meta-analysis model and estimated summary measures compared buprenorphine maintenance to methadone maintenance on several outcomes.
  • n=515 neonates whose mothers received BMT and n=855 neonates whose mothers received MMT; 12 studies.
  • Prenatally buprenorphine-exposed babies had:
  • Lower NAS treatment risk (risk ratio [RR]=0.90, 95% CI: 0.81, 0.98)
  • Shorter length of hospital stay (-7.23 days, 95% CI: -10.64, -3.83)
  • Higher mean gestational age
  • Greater weight, length, and head circumference at birth
  • In treated neonates,
  • NAS treatment duration was shorter (-8.46 days, 95% CI: -14.48, -2.44)
  • Morphine dose lower (-3.60 mg, 95% CI: -7.26, 0.07)
  • …than neonates exposed to methadone.
  • Buprenorphine-exposed neonates - fewer women treated with buprenorphine used illicit opioids near delivery (RR=0.44, 95% CI: 0.28, 0.70).
  • Brogly et al., Am J Epidemiol 2014
  • Methadone and Buprenorphine: Outcomes
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