• Elizabeth A Suarez, Krista F Huybrechts, Loreen Straub, Sonia Hernández-Díaz, Hendrée E Jones, Hilary S Connery, Jonathan M Davis, Kathryn J Gray, Barry Lester, Mishka Terplan, Helen Mogun, and Brian T Bateman.
• From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.).
• N. Engl. J. Med. 2022 Dec 1; 387 (22): 203320442033-2044.

BackgroundOpioid agonist therapy is strongly recommended for pregnant persons with opioid use disorder. Buprenorphine may be associated with more favorable neonatal and maternal outcomes than methadone, but existing data are limited.MethodsWe conducted a cohort study involving pregnant persons who were enrolled in public insurance programs in the United States during the period from 2000 through 2018 in which we examined outcomes among those who received buprenorphine as compared with those who received methadone. Exposure to the two medications was assessed in early pregnancy (through gestational week 19), late pregnancy (gestational week 20 through the day before delivery), and the 30 days before delivery. Risk ratios for neonatal and maternal outcomes were adjusted for confounders with the use of propensity-score overlap weights.ResultsThe data source for the study consisted of 2,548,372 pregnancies that ended in live births. 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). Neonatal abstinence syndrome occurred in 52.0% of the infants who were exposed to buprenorphine in the 30 days before delivery as compared with 69.2% of those exposed to methadone (adjusted relative risk, 0.73; 95% confidence interval [CI], 0.71 to 0.75). Preterm birth occurred in 14.4% of infants exposed to buprenorphine in early pregnancy and in 24.9% of those exposed to methadone (adjusted relative risk, 0.58; 95% CI, 0.53 to 0.62); small size for gestational age in 12.1% and 15.3%, respectively (adjusted relative risk, 0.72; 95% CI, 0.66 to 0.80); and low birth weight in 8.3% and 14.9% (adjusted relative risk, 0.56; 95% CI, 0.50 to 0.63). Delivery by cesarean section occurred in 33.6% of pregnant persons exposed to buprenorphine in early pregnancy and 33.1% of those exposed to methadone (adjusted relative risk, 1.02; 95% CI, 0.97 to 1.08), and severe maternal complications developed in 3.3% and 3.5%, respectively (adjusted relative risk, 0.91; 95% CI, 0.74 to 1.13). Results of exposure in late pregnancy were consistent with results of exposure in early pregnancy.ConclusionsThe use of buprenorphine in pregnancy was associated with a lower risk of adverse neonatal outcomes than methadone use; however, the risk of adverse maternal outcomes was similar among persons who received buprenorphine and those who received methadone. (Funded by the National Institute on Drug Abuse.).Copyright © 2022 Massachusetts Medical Society.

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