Buprenorphine + naloxone found to be safe for opioid addiction in pregnancy

Pregnancies exposed to buprenorphine combined with naloxone have similar or more favorable neonatal and maternal outcomes as those exposed to buprenorphine alone, according to a study published online Aug. 12 in the Journal of the American Medical Association.

Loreen Straub, M.D., from Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues compared perinatal outcomes following prenatal exposure to buprenorphine with naloxone versus buprenorphine alone in a population-based cohort study using health care utilization data from Medicaid-insured beneficiaries.

The study included 3,369 pregnant individuals exposed to buprenorphine with naloxone during the first trimester and 5,326 exposed to buprenorphine alone.

The researchers found that comparing buprenorphine combined with naloxone with buprenorphine alone resulted in significantly lower risks for neonatal abstinence syndrome, neonatal intensive care unit admission, and small for gestational age (weighted relative risks, 0.77, 0.91, and 0.86, respectively).

The weighted relative risk was not significantly different for maternal morbidity (comparative rates, 2.6 versus 2.9 percent). There were no differences seen with respect to major congenital malformations overall, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. Across sensitivity analyses, the results were consistent.

"This supports the view that both formulations are reasonable options for treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making," the authors write.

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