Examining outcomes for buprenorphine/naloxone induction and use in women with opioid use disorder that are pregnant: A retrospective cohort analysis
Creators: name: Banasiewicz, Benjamin
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2018

description: Objective: To compare maternal, fetal and neonatal clinical characteristics and outcomes of Horizons’ clinic induction and community induced transfers of buprenorphine/naloxone treatment during pregnancy. Methods:  We conducted a retrospective cohort analysis of patients treated with buprenorphine/naloxone for opioid use disorder during pregnancy and their prenatally opioid-exposed neonates. N= 319 mother-neonate dyads were treated at the University of North Carolina Horizons’ Clinic between January 1, 2014 and May 31, 2018. Based on eligibility criteria, compared were n=51 mother-neonate dyads that underwent buprenorphine/naloxone induction via the Horizons’ Clinic protocol versus n=44 mother-neonate dyads that underwent community buprenorphine/naloxone induction via an outside provider and transferred to Horizons’ for prenatal care and management of medications for addiction treatment (MAT) during pregnancy. All patients were generally scheduled for weekly or bi-weekly prenatal visits during which they would see a buprenorphine certified provider, a licensed therapist, and a peer support specialist. Demographic data as well as maternal, fetal, and neonatal clinical characteristics and outcomes were collected via chart review. Maternal data included race, age at delivery, parity, total prenatal visits, total postpartum visits, participation in Horizons’ residential treatment program at the time of pregnancy, maternal tobacco use, other illicit substance use, and psychiatric diagnosis. Fetal data included estimated gestational age (EGA) at initial prenatal, percentage of fetal heart rates (FHR) that were within normal limits (120 – 160 bpm), estimated fetal weight (EFW) percentile (adjusted for gestational age) based on ultrasound, and comments from anatomy ultrasounds. Neonatal outcomes included: gestational age at birth, birth weight in grams, mode of delivery, 1 and 5-minute APGAR scores, newborn days in nursery, and if medication treatment (typically morphine) was required for neonatal abstinence syndrome (NAS). Data for preterm birth and low birth weight were also compared to North Carolina state averages.Results: No significant differences were found in maternal clinical characteristics between the Horizons’ induction group and the community induced transfers. There is evidence that the Horizons’ induction group had significantly higher mean EFW percentile compared to those who underwent community induction (41.8 vs. 35.7, P=0.042). EFW percentile was the only fetal outcome to have a significant difference. No significant differences were found in neonatal outcomes between the two groups. In addition, no significant differences in preterm birth or low birth weight were found between Horizons’ induction group and the North Carolina state averages.Conclusion: UNC Horizons’ induction protocol shows similar safety and effectiveness in pregnancy outcomes when compared to community induced transfers. The outcomes for both groups showed relative safety and effectiveness of buprenorphine/naloxone during pregnancy, adding to the existing literature. Having alternative induction protocols, such as Horizons’ protocol, would help expand access to MAT by providing more options for both patients and providers.