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


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



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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
  • Heil et al., Addiction, 2012
  • 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
  • Buprenorphine-exposed neonates had higher mean scores on sneezing
  • Heil et al., Addiction, 2012
  • MOTHER: Buprenorphine v. Methadone NAS Signs

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:
    • greater FHR variability
    • more accelerations
    • better FM-FHR coupling early in the second half of gestation
  • 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
  • FHR variability
  • 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*
  • FHR-FM coupling, %
  • 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:
    • a higher incidence of preterm labor
    • a higher percentage of respiratory distress signs in neonates
  • p < .05
  • p < .05
  • Holbrook et al., Addiction, 2012

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