Monitoring neonatal abstinence syndrome in buprenorphine-exposed in vitro fertilization twins: A case study

ABSTRACT

Background: Prior studies have reported on the pregnancies and outcomes of in vitro fertilization (IVF) in special subpopulations; however, there is a lack of studies on opioid-exposed IVF-conceived neonates. Case Presentation: A young adult IVF-pregnant woman was maintained on buprenorphine throughout pregnancy and received follow-up from the addiction clinic from estimated gestational week 32. She delivered healthy dichorionic twins via cesarean section at 38 weeks gestational age (buprenorphine dose at time of delivery: 16 mg). All maternal supervised urinalysis taken as of gestational week 32 were negative for concomitant substances (prior to treatment initiation at the addiction clinic, only self-reports of abstinence from concomitant substances were available). Both healthy children (male birth weight: 3140 g, female birth weight: 2650 g) developed an unusual course of neonatal abstinence syndrome (NAS) requiring extensive treatment (total morphine dose male: 22 mg, and female: 26.75 mg; length of treatment: 33 and 34 days, respectively; duration of hospitalization: 40 days). Discussion: The highly severe and long-lasting NAS in both neonates represents a very unusual course following an uneventful pregnancy, and influencing iatrogenic factors cannot be ruled out. Given the multiple variables influencing infant outcomes, this highlights the importance of high-quality, evidence-based standard operating procedures, which (1) are initiated as early as possible during pregnancy to minimize risk factors for adverse infant outcomes, such as concomitant substance use during pregnancy; (2) support the substance-dependent woman throughout the postpartum period, especially in cases of multiple and/or IVF-conceived pregnancies, where additional challenges may arise; and (3) consider the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

KEYWORDS:

• Buprenorphine
• IVF twin pregnancy
• neonatal abstinence syndrome

Acknowledgments

We are indebted to our patient for allowing us to publish these data. Our gratitude also goes to the nursing staff dedicated to the provision of excellent care.

The authors declare that they have no conflicts of interest.

Author contributions

Laura Brandt elaborated and wrote the first draft of the manuscript. Annemarie Unger and Gabriele Fischer supervised, consulted, and supported Laura Brandt and contributed to/revised essential sections of the paper. Patrick Swoboda was part of the study team and was involved in editing, revising, and reviewing the manuscript. All authors contributed to, and have approved, the final manuscript for submission.

Funding

Gabriele Fischer received funding from the Austrian National Bank Jubilee Fund (project no. 13637) that enabled the project within which the data of the present case were collected. The Austrian National Bank had no role in study design, collection, and analysis/interpretation of data; in the writing of the manuscript; or the decision to submit the manuscript for publication.