Study: Opioid use disorder treatment improves pregnancy outcomes

(Press-News.org) Pregnant women living with opioid use disorder (OUD) and their infants had significantly better health outcomes when treated with buprenorphine, according to a new study at Vanderbilt University Medical Center and Emory University’s Rollins School of Public Health. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu. 

Pregnant women who received buprenorphine, a medication used to treat OUD, were less likely to have a preterm birth, face serious health complications, or have their infants hospitalized in the NICU compared to those who did not receive the treatment, the study found.

“We know that treatment with medications like buprenorphine substantially reduces the risk of overdose death for pregnant women with opioid use disorder, but its benefits to newborns have not been well understood,” said Stephen Patrick, MD, MPH, senior author and chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health. “We found a profound reduction in preterm birth among infants whose mothers were treated with buprenorphine, which can have a lifelong impact.”

Despite rates of OUD in pregnant women increasing more than fivefold from 1999 to 2017, more than half still do not receive treatment, researchers said. Previous research estimates that up to 20% of pregnant women with OUD may have a preterm birth, nearly double those without OUD. Preterm birth, a growing public health issue, increases the risk of health problems in children, including respiratory issues, infections, cerebral palsy, developmental delays, and vision and hearing problems.

Researchers also noted stark disparities in equitable care. Those receiving buprenorphine were significantly less likely to be Black.

“Disparities in access to buprenorphine significantly affect vulnerable populations, including pregnant women,” said Sunaya Krishnapura, graduating medical student at Vanderbilt University School of Medicine and presenting author. “Our findings underscore the urgent need for policies that expand treatment access in the United States to ensure a healthy pregnancy and future for mothers and infants.”

The study examined more than 14,000 pregnant women with OUD who were enrolled in Tennessee Medicaid between 2010 and 2021.

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EDITOR:
Sunaya Krishnapura will present “Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes” on Sun., April 27 from 5:30-5:45 PM ET.
Reporters interested in an interview with Sunaya should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes

Presenting Author: Sunaya Krishnapura

Organization
Vanderbilt University School of Medicine; Rollins School of Public Health, Emory University

Topic
Public Health & Prevention

Background
Opioid use disorder (OUD) in pregnancy is associated with adverse perinatal outcomes. Treatment with methadone or buprenorphine, both opioid agonists, is recommended to improve pregnancy outcomes. Much of the existing research has evaluated the effectiveness and efficacy of methadone compared to buprenorphine, but limited evidence remains comparing buprenorphine to no treatment. As most pregnant individuals still do not receive treatment for OUD, there is a public health imperative to examine how buprenorphine treatment compared to no treatment influences maternal-infant outcomes.

Objective
To determine if treatment with buprenorphine improves maternal outcomes (severe maternal morbidity (SMM), ICU admission, maternal mortality) and infant outcomes (preterm birth, NICU admission, infant mortality) compared to no treatment.

Design/Methods
This retrospective cohort study between 2010-2021 included maternal-infant dyads with a diagnosis of OUD and enrolled in Tennessee Medicaid from 20 weeks estimated gestational age (EGA) to 6 weeks postpartum using Medicaid claims linked to vital statistics. The exposure of interest was buprenorphine treatment, defined by filled prescriptions between 20 weeks EGA to birth. We calculated descriptive statistics and created propensity scores with overlapped weighting to account for treatment bias between groups.

Results
Among 14,463 who met our inclusion criteria, 7,469 dyads received buprenorphine treatment. Compared to those who were treated, pregnant individuals who did not receive treatment were more likely to be non-Hispanic Black (10% vs. 2.1%; p< 0.001; Table 1). The crude percentage of adverse perinatal outcomes was significantly lower in dyads treated with buprenorphine compared to the untreated group (25% vs. 31%; p< 0.001); the treatment group had a lower percentage of SMM events, preterm births, and NICU admissions (Table 2). In adjusted propensity score analyses, dyads treated prenatally with buprenorphine had 5.1% (95% CI, 3.5%-6.7%) lower probability of adverse pregnancy outcomes, including a 1.2% (95% CI, 0.4%-2.1%) lower probability of SMM, 1.7% (95% CI, 0.4%-2.9%) lower probability of NICU admission, and 5.3% (95% CI, 4.0%-6.6%) lower probability of preterm birth (Figure 1).

Conclusion(s)
In a large population-based cohort, we found that receipt of buprenorphine during pregnancy improved outcomes for both mother and infant, underscoring the need to improve access to treatment nationwide.

Tables and Images
Table 1.png
Table 2.png
Figure 1.png

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