Background/Aims: To determine whether there is a dose-response relationship between maternal dose of buprenorphine at delivery and neonatal outcomes. Methods: This retrospective cohort study of 155 maternal-infant dyads exposed to buprenorphine during pregnancy examines the relationship between maternal dose of buprenorphine at delivery and gestational age, birthweight, method of delivery, Apgar scores at 1 and 5 min, duration of infant hospital stay, peak neonatal abstinence syndrome (NAS) score, duration of NAS and incidence of pharmacologic treatment of NAS. Results: Analyses failed to support any relationship between maternal dose of buprenorphine at delivery and any of the 9 clinical outcomes (all p values >0.093). Conclusions: This study failed to provide any evidence to support limiting or reducing maternal dose of buprenorphine during pregnancy in order to reduce possible adverse outcomes to the infant. Findings suggest that healthcare providers can focus medication decisions on maternal opioid cravings to reduce the risk of relapse to illicit opioid use rather than out of concern for adverse infant outcomes.

Keywords:
Buprenorphine, Pregnancy, Dose, Opioid use disorders
1.
Brogly SB, Saia KA, Walley AY, Du HM, Sebastiani P: Prenatal buprenorphine versus methadone exposure and neonatal outcomes: systematic review and meta-analysis. Am J Epidemiol 2014;180:673-686.
2.
Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, et al: Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010;363:2320-2331.
3.
Kaltenbach K, Holbrook AM, Coyle MG, Heil SH, Salisbury AL, Stine SM, et al: Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction 2012;107(suppl 1):45-52.
4.
O'Connor AB, O'Brien L, Alto WA: Are there gender related differences in neonatal abstinence syndrome following exposure to buprenorphine during pregnancy? J Perinat Med 2013;41:621-623.
5.
O'Connor AB, O'Brien L, Alto WA, Wong J: Does concurrent in utero exposure to buprenorphine and antidepressant medications influence the course of neonatal abstinence syndrome? J Matern Fetal Neonatal Med 2015;Jul 8:1-3, Epub ahead of print.
6.
Jones HE, Dengler E, Garrison A, O'Grady KE, Seashore C, Horton E, et al: Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy. Drug Alcohol Depend 2014;134:414-417.
7.
Lejeune C, Simmat-Durand L, Gourarier L, Aubisson S; Groupe d'Etudes Grossesse et Addictions (GEGA): Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenorphine substitution. Drug Alcohol Depend 2006;82:250-257.
8.
Kacinko SL, Jones HE, Johnson RE, Choo RE, Huestis MA: Correlations of maternal buprenorphine dose, buprenorphine, and metabolite concentrations in meconium with neonatal outcomes. Clin Pharmacol Ther 2008;84:604-612.
9.
Hudak ML, Tan RC; Committee on Drugs; Committee on Fetus and Newborn; American Academy of Pediatrics: Neonatal drug withdrawal. Pediatrics 2012;129:e540-e560.
10.
Good P: Permutation Tests: A Practical Guide to Resampling Methods for Testing Hypotheses, ed 2. New York, Springer, 2000, pp 120-121.
11.
Efron B, Tibshirani RJ: An Introduction to the Bootstrap. Boston, Chapman & Hall, 1993, pp 220-222.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.