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Comparative Safety Analysis of Opioid Agonist Treatment in Pregnant Women with Opioid Use Disorder: A Population-Based Study

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Listed:
  • Shuang Wang

    (University of Rhode Island)

  • Kimford J. Meador

    (Stanford University)

  • Jayne Pawasauskas

    (University of Rhode Island)

  • Adam K. Lewkowitz

    (Alpert Medical School of Brown University)

  • Kristina E. Ward

    (University of Rhode Island)

  • Todd N. Brothers

    (University of Rhode Island)

  • Abraham Hartzema

    (University of Florida)

  • Brian J. Quilliam

    (University of Rhode Island)

  • Xuerong Wen

    (University of Rhode Island)

Abstract

Introduction and Objective Receipt of opioid agonist treatment during early and late pregnancy for opioid use disorder may relate to varying perinatal risks. We aimed to assess the effect of time-varying prenatal exposure to opioid agonist treatment using buprenorphine or methadone on adverse neonatal and pregnancy outcomes. Methods We conducted a retrospective cohort study of pregnant women with opioid use disorder using Rhode Island Medicaid claims data and vital statistics during 2008–16. Time-varying exposure was evaluated in early (0–20 weeks) and late (≥ 21 weeks) pregnancy. Marginal structural models with inverse probability of treatment weighting were applied. Results Of 400 eligible pregnancies, 85 and 137 individuals received buprenorphine and methadone, respectively, during early pregnancy. Compared with 152 untreated pregnancies with opioid use disorders, methadone exposure in both periods was associated with an increased risk of preterm birth (adjusted odds ratio [aOR]: 2.52; 95% confidence interval [CI] 1.07–5.95), low birth weight (aOR: 2.99; 95% CI 1.34–6.66), neonatal intensive care unit admission (aOR, 5.04; 95% CI 2.49–10.21), neonatal abstinence syndrome (aOR: 11.36; 95% CI 5.65–22.82), respiratory symptoms (aOR, 2.71; 95% CI 1.17–6.24), and maternal hospital stay > 7 days (aOR, 14.51; 95% CI 7.23–29.12). Similar patterns emerged for buprenorphine regarding neonatal abstinence syndrome (aOR: 10.27; 95% CI 4.91–21.47) and extended maternal hospital stay (aOR: 3.84; 95% CI 1.83–8.07). However, differences were found favoring the use of buprenorphine for preterm birth versus untreated pregnancies (aOR: 0.17; 95% CI 0.04–0.77), and for several outcomes versus methadone. Conclusions Methadone and buprenorphine prescribed for the treatment of opioid use disorder during pregnancy are associated with varying perinatal risks. However, buprenorphine may be preferred in the setting of pregnancy opioid agonist treatment. Further research is necessary to confirm our findings and minimize residual confounding.

Suggested Citation

  • Shuang Wang & Kimford J. Meador & Jayne Pawasauskas & Adam K. Lewkowitz & Kristina E. Ward & Todd N. Brothers & Abraham Hartzema & Brian J. Quilliam & Xuerong Wen, 2023. "Comparative Safety Analysis of Opioid Agonist Treatment in Pregnant Women with Opioid Use Disorder: A Population-Based Study," Drug Safety, Springer, vol. 46(3), pages 257-271, March.
    • Handle: RePEc:spr:drugsa:v:46:y:2023:i:3:d:10.1007_s40264-022-01267-z
    DOI: 10.1007/s40264-022-01267-z
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    1. Mary A. Burke & Riley Sullivan, 2021. "The Medicaid Expansion and the Uptake of Medication-assisted Treatment for Opioid Use Disorder: Evidence from the Rhode Island All-payer Claims Database, 2012–2018," Current Policy Perspectives 90307, Federal Reserve Bank of Boston.
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