Is Weaning of Buprenorphine Safe for Pregnant Women with Opioid Use Disorder?

Background: The American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM) currently recommend opioid agonist pharmacotherapy with methadone or buprenorphine as the optimal treatment option for opioid use disorder during pregnancy. A common expected consequence of neonates exposed to opioids during the intrapartum period is neonatal abstinence syndrome (NAS). NAS frequency has paralleled the escalated use of opioids in the recent decade, and as a result, the costs necessary to treat these infants has increased as well. Medically supervised tapering from opioids during pregnancy remains controversial and is largely understudied, but many addicted pregnant individuals report wanting to cut down use during pregnancy. The supported current standard of care is based on case reports that have demonstrated increased fetal distress, preterm labor, and a high maternal relapse rate during detoxification; however, there is a growing number of literature in the modern obstetric era studying the safety of detoxification during pregnancy that have shown positive pregnancy results. .

Methods: This study aimed to perform a secondary data analysis of studies reporting on fetal outcomes following tapering of buprenorphine during pregnancy to determine whether detoxification from buprenorphine during pregnancy is effective and safe. Only studies reporting on pregnancy outcomes following tapering from buprenorphine specifically were eligible for the preliminary analysis. Another preliminary analysis looking at pregnancy outcomes in buprenorphine tapered mothers compared to mothers whose dose was not tapered was also done. One sample T-test was used to determine preterm rate and fetal demise rate in this population versus national/CDC data of prematurity and fetal demise.

Results: A total of 5 publications met the criteria during the literature search. Further, the data used for this secondary data analysis includes preliminary data from an ongoing study looking at buprenorphine detoxification, giving a total of 6 eligible publications. In 259 pregnancies, no increased of fetal or maternal risk due to tapering from buprenorphine was identified compare to national average of preterm rate and fetal demise. The one sample T-test showed that there is no significant difference between preterm labor rate and the national rate with a t-score of 5.642, and no significant difference between fetal demise rate and the national rate with a p-value of 0.191.

Conclusion: Pregnant mothers who chose to taper their buprenorphine dosage during pregnancy did not seem to show higher risks of fetal or maternal demise. The high prevalence of opioid use disorder during pregnancy and these results suggest that pregnant individuals should be offered the option to attempt to taper off buprenorphine during pregnancy.