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Objective: Opioid maintenance therapy (OMT) with methadone or buprenorphine is the first line treatment of opioid dependency in pregnant women. Opioids as other medications cross the placenta and thus bear the risk of neonatal abstinence syndrome (NAS). Furthermore, frequent comorbid disorders in opioid addiction like nicotine dependence pose further risks for neonates, i.e. growth retardation. The aim of the present study was to assess differences in neonatal outcomes as a function of different maternal OMT (methadone vs. buprenorphine). Furthermore, differences and improvements of therapy methods and neonatal outcomes over the last decade were evaluated.
Method: A prospective, standardized, observational study design was used for the analysis of 68 mothers in multidisciplinary treatment at the Addiction Clinic of the Medical University of Vienna and their neonates. 39 (57,4%) of the mothers were maintained with methadone (daily mean dose at time of delivery: 58,62 mg, SD= 34,09 mg) and 29 (42,6%) with buprenorphine (9,60 mg, SD=6,53 mg) during pregnancy. Childrens’ data and their postpartal surveillance were derived from the hospitals’ individual documentary systems. Infant’s NAS was assessed by a modified Finnegan scale and treated with standardized pharmacological intervention.
Results: Results showed a significant benefit of buprenorphine in dose of medication needed for the treatment of neonates’ postpartal withdrawal and detoxification (p=0,006) and length of NAS-treatment (methadone: 18.9 days, buprenorphine: 12.4 days; p=0,021). Regarding neonatal outcomes (birth weight, length, head circumference and gestational age) no significant differences between methadone and buprenorphine exposed neonates were observed. Breast feeding did not show a significant protective inşuence on developing a NAS. The comparison to the data gathered in a comparable study design 10 years ago showed that the duration of pregnancy in opioid-dependent women could significantly be elongated from 38th to 39th week of gestation (p= 0,033) and the length of medical treatment for NAS was shortened from 18.9 to 16.1 days (p= 0,024).
Conclusion: Opioid maintenance therapy with buprenorphine compared to methadone during pregnancy has several advantages in terms of neonatal outcomes. However, a broader concept of medical treatment is important for both medications and enables a multidisciplinary care approach. A standardized pharmacological approach in pregnant women and their neonates reduces treatment costs.