Category: Medical/Surgical/Diseases/Complications
Poster Session III
To assess the effect of buprenorphine dose on fetal, neonatal, and maternal outcomes.
Study Design:
This retrospective cohort study included singleton pregnancies who delivered from 10/01/16—12/31/21 with daily exposure to buprenorphine by 23 weeks gestation. Exclusion criteria were medical comorbidities associated with fetal growth restriction (FGR). The mode buprenorphine dose in the third trimester was categorized: ≤8 mg, 9-16 mg, and >16 mg. The primary outcome was the Pearson correlation coefficient for birthweight percentiles, as determined by Fenton (preterm) and Olsen (term) birthweight curves, stratified by dose. Related fetal and neonatal (e.g., biometrics, umbilical artery Doppler [UAD] abnormalities, NICU admission), and maternal (e.g., hypertensive disorders of pregnancy, cesarean) outcomes were assessed.
Results:
Study criteria was met by 415 patients. An inverse relationship between buprenorphine dose and the birthweight percentile was observed (r = -0.15, 95% CI, -0.25, -0.06). The birthweight percentile was 44.0%, 37.2%, and 29.2% for daily exposure to ≤8 mg, 9-16 mg, and >16 mg, respectively (p= < 0.01). FGR was identified in 73 (17.6%) pregnancies, of which 10 had severe FGR (2.4%). A subset of FGR pregnancies (n=54) received UAD measurements, of which 16 (29.6%) had UAD abnormalities: 15 (93.8%) had elevated systolic/diastolic flow and one had absent end diastolic flow. Delivery prior to 39 weeks was indicated secondary to FGR surveillance abnormalities in 19 (26.0%) pregnancies. Increasing buprenorphine dose was associated with increasing risk for NICU admission (17.0%, 25.0%, 33.5%, p=0.01) and cesarean delivery (22.7%, 33.3%, 37.4%, p=0.04). Other assessed outcomes were not affected by dose.
Conclusion:
Increasing buprenorphine dose is associated with decreasing birthweight and increased risk for NICU admission and cesarean delivery. This is the first study to describe the rate of severe FGR and the type of umbilical artery Doppler abnormalities associated with buprenorphine. Pregnant patients taking buprenorphine require serial fetal growth assessment to detect FGR.
Richard Vigh, MD
Fellow
Geisinger
Danville, Pennsylvania, United States
Amanda J. Young, MS
Geisinger Medical center
Danville, Pennsylvania, United States
Celia Gray, BS
Geisinger
Geisinger, Pennsylvania, United States
A. Dhanya Mackeen, MD,MPH
Geisinger Medical Center
Danville, Pennsylvania, United States