Receipt of Buprenorphine in Pregnancy Associated With a Lower Risk of Adverse Neonatal Outcomes Than Methadone

Opioid use disorder (OUD) is a major cause of morbidity among pregnant persons and their offspring. Both methadone and buprenorphine are effective in the treatment of OUD, but it is unclear whether one is superior to the other in terms of maternal or fetal morbidity. This study examined US Medicaid data for pregnant persons from 2000 to 2018 and compared rates of neonatal abstinence syndrome (NAS), preterm birth, low birth weight, and small for gestational age (SGA) among infants exposed in utero to buprenorphine or methadone in early and late pregnancy. The authors also compared maternal outcomes.

• In early pregnancy, 10,704 pregnant persons were exposed to buprenorphine and 4387 to methadone. In late pregnancy, 11,272 were exposed to buprenorphine and 5056 to methadone (9976 and 4597, respectively, in the 30 days before delivery).
• NAS occurred in 69 percent of infants exposed to methadone versus 52 percent of those exposed to buprenorphine (relative risk, 0.73).
• For early pregnancy, the rates of adverse outcomes were significantly higher in infants exposed to methadone compared with buprenorphine: preterm birth (25 versus 14 percent), low birth weight (15 versus 8 percent), and SGA (15 versus 12 percent).
• For late pregnancy, the rates of adverse outcomes were likewise higher among infants with methadone exposure compared with buprenorphine: preterm birth (25 versus 14 percent), low birth weight (14 versus 8 percent), and SGA (16 versus 13 percent).
• No difference was found in maternal outcomes, including rates of cesarean section and severe complications.

Comments: While this study is important and can inform anticipatory guidance for pregnant persons with OUD, it is vital that individuals with OUD receive the medication that works best for them. Both methadone and buprenorphine are effective and can be used during pregnancy.

Corey McBrayer, DO, MPH* & Darius A. Rastegar, MD

* Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus methadone for opioid use disorder in pregnancy. N Engl J Med. 2022;387(22):2033–2044.