Earlier this month we covered the topic of opioid use after a tonsillectomy in pediatric patients. This week we cover opioid choice in pregnancy, and see if a newer drug for withdrawal syndrome treatment shows better positive outcomes over the current standard. The Read List is a biweekly update on pharmaceutical literature. Every two weeks we handpick one of the most relevant and interesting pharmacy-related publications and summarize it for your convenience. At the end of every month, a quiz on that month’s content will be released. Simply take the quiz, and you’ll be automatically entered into a draw for a gift card prize!
This is the last Read List of the month so we have a new quiz for you! Correctly answer the questions and you’ll be entered into a draw for a $10 Starbucks gift certificate!
Instructions to access: Copy and paste the article title into UBC Summons to read the full article, or click on the link below to access the article via UBC EZproxy.
Untreated opioid addiction during pregnancy is associated with adverse maternal and perinatal complications. Medication-assisted treatment is often used to improve obstetric outcomes but its use during pregnancy may cause neonatal abstinence syndrome (NAS), i.e. infant withdrawal leading to developmental changes and a poor adaptation process. Methadone has been traditionally used in pregnancy since the 1970s while buprenorphine recently became available in 2002. Buprenorphine has been reported to have less overdose potential, fewer drug interactions, a milder NAS, and is also available in combination with naloxone (opioid antagonist). However, there is limited literature on pregnancy outcomes among women taking buprenorphine and naloxone. Wiegand et al. set out to compare NAS prevalence and characteristics among neonates born to women prescribed buprenorphine and naloxone compared with methadone during pregnancy. Primary neonatal outcomes included diagnosis of NAS, NAS peak scores, total amount of morphine used to treat NAS (mg), and duration of treatment for NAS (days). Secondary outcomes included neonatal head circumference, birth weight, length, preterm birth, neonatal intensive care unit admission, Apgar scores, and overall length of hospitalization. 62 mother-neonate dyads were identified via a retrospective, cohort analysis over 3 years (Jan. 2011-Nov. 2013) with 31 pairs treated with methadone and 31 treated with buprenorphine and naloxone. Sixteen neonates (51.6%) in the methadone group were diagnosed with NAS compared with eight (25.1%) in the buprenorphine and naloxone group. The buprenorphine and naloxone-exposed neonates had lower peak NAS scores and shorter overall hospitalization. There were no other differences in primary or secondary outcomes. Because NAS scores were assessed as part of routine clinical care, assessors were therefore not blinded to maternal opioid treatment. Another limitation is the observational and retrospective nature of this study with the potential for uncontrolled confounding (e.g. the groups differed in their indications for opioid use). A formal power calculation was not performed because this was a retrospective study with a fixed number of patients. Given such limitations, this study still demonstrated the potential benefits of treating opioid addiction with buprenorphine and naloxone in pregnant women with implications of improving neonatal outcomes.
– Ainge Chang
B.Sc. (Pharm) Candidate 2016