Weaning buprenorphine in pregnant patients^#

Figures & data

Table 1. Comparative maternal characteristics of pregnant patients with OUD: buprenorphine weaned vs. maintained.

	Buprenorphine wean N = 39	Did not wean buprenorphine N = 295	p Value
Maternal characteristics
Age	28.9 ± 5.4	29.2 ± 4.9	0.73
Race
Asian	0	1 (0.3%)	1.00
More than 1 race	0	3 (1.0%)
Black or African American	0	4 (1.4%)
White	39 (100%)	287 (97.3%)
Insurance type
Insured*	39 (100%)	286 (97.3%)	0.60
Uninsured	0	8 (2.7%)
Tobacco use in pregnancy	33 (84.6%)	250 (85.3%)	0.31
Electronic cigarette use	11 (28.9%)	29 (10.4%)	0.02
Fagerstrom Test	5.3 ± 1.4	4.7 ± 2.1	0.35
MAOD started prior to the pregnancy	7 (20.6%)	55 (20.8%)	1.00
Total buprenorphine dose (mg/day)	10.6 ± 5.6	10.3 ± 4.6	0.76
Total naloxone dose (mg/day)	2.3 ± 1.3	2.6 ± 1.1	0.29
History of overdose	5 (33.3%)	53 (47.3%)	0.41
Concurrent psychiatric diagnoses at enrollment
Bipolar disorder	6 (17.6%)	35 (12.5%)	0.41
Anxiety	15 (44.1%)	156 (55.5%)	0.27
Panic disorder	0 (0%)	7 (2.5%)	1.00
ADHD	2 (5.9%)	12 (4.3%)	0.65
PTSD	1 (2.9%)	20 (7.1%)	0.71
AAS Score = 1**	19 (48.7%)	148 (50.2%)	1.00
Enrollment GAD-7 Score ≥10***	5 (41.7%)	59 (50.4%)	0.76
ACE Score****	3.9 ± 3.1	3.9 ± 2.5	0.88
Enrollment Edinburgh score ≥12	7 (53.8%)	56 (47.5%)	0.77
Average Enrollment Edinburgh Score	12.4 ± 6.0	11.5 ± 6.3	0.64

*Most insurance was government/public assisted. **AAS, Abuse Assessment Score; ***GAD, Generalized anxiety disorder; ****ACE, adverse childhood experiences.

Table 2. Comparative maternal and neonatal outcomes of pregnant patients with OUD: buprenorphine weaned vs. maintained.

	Buprenorphine wean N = 39	Did not wean buprenorphine N = 295	p Value
Maternal outcomes
Mode of delivery			0.17
Vaginal delivery	20 (51.3%)	157 (53.8%)
Operative vaginal delivery	5 (12.8%)	15 (5.1%)
Cesarean section	14 (35.9%)	120 (41.1%)
MAOD dose at delivery	4.4 ± 4.6	13.0 ± 4.7	<0.001
Postpartum Edinburgh score ≥12	1 (9.1%)	15 (22.7%)	0.44
Average postpartum Edinburgh Score	4.7 ± 4.1	8.2 ± 5.7	0.05
Maternal deaths	0 (0%)	4 (1.4%)	1.00
Prenatal adverse event
(Any of the following): arrested, birth <28 gestation, miscarriage (<20 weeks), fetal demise >20 weeks, illness or injury associated with substance abuse, relapse, victimization	16 (41%)	148 (50.2%)	0.31
Total number of prenatal visits	14.1+/−7.2	13.6+/−6.7	0.69
Number of inappropriate prenatal visits
Self-reported illicit drug use, inappropriate UDT, no show appointment	4.5+/−5.9	4.7+/−6.1	0.82
PP severe adverse events
Prolongation of hospitalization (including medical or psychiatric hospitalization)	1 (2.6%)	14 (4.7%)	1.00
PP adverse events
Relapse illness	10 (25.6%) 8	114 (38.6%)	0.16
Injury associated with SUD	(20.5%)	51 (17.3%)	0.66
Total number of PP Visits	3.9+/−3.3	4.5+/−2.7	0.29
Breastfeeding at discharge	10 (26.3%)	63 (20.9%)	0.53
Rooming in with infant	18 (50%)	152 (53%)	0.86
Neonatal outcomes
Birth weight	3047 ± 632	2932 ± 517	0.96
Birth weight percentile	44.3 ± 29.9	34.8 ± 24.4	0.03
Small for gestational age births	3 (7.9%)	43 (14.6%)	0.03
APGAR 1 min	7.7 ± 1.7	7.9 ± 1.6	0.33
APGAR 5 min	8.4 ± 1.2	8.6 ± 1.0	0.86
Infant treated for NOWS	9 (23.1%)	137 (46.6%)	0.01
Highest Finnegan Score	9.6 ± 4.5	12.3 ± 4.0	<0.001
Length of NOWS treatment (days)	13.0 ± 5.6	16.1 ± 9.3	0.33
Infant admitted to NICU	26 (66.7%)	227 (77.2%)	0.16
Total length of hospital stay (in days)	11.1 ± 15.2	15.6 ± 18.1	0.15
MDT with buprenorphine metabolite*	24 (72.7%)	258 (94.9%)	<0.001
UDT with buprenorphine metabolite**	23 (59%)	264 (90.7%)	<0.001

*MDT, Meconium drug test; **UDT, urine drug test.

Data availability statement

Due to the nature of the research, due to ethical and privacy concerns, supporting data is not available.