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Clinical Obstetrics

Poster Session 1

(267) Differences in dosing strategies and perinatal outcomes for pregnant patients on buprenorphine compared with methadone

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: There is limited data evaluating differences in dosing and outcomes of patients on methadone and buprenorphine, two common medications for opioid use disorder (MOUD). This study sought to evaluate dosing alterations in pregnancy as well as to compare perinatal outcomes between buprenorphine based MOUD and methadone.

Study Design: Retrospective cohort study comprised of patients with opioid use disorder (OUD) during their pregnancy who delivered at a single institution between January 2017 and July 2023. Patients were divided according to their prescribed MOUD: buprenorphine-based and methadone. Exclusion criteria: patients with OUD who were not described MOUD during their prenatal care. These groups were compared using Chi-square, McNemar test, t-tests with statistical significance defined as p < 0.05.

Results: With respect to dosing, more patients in the methadone group required dosage changes (n=50, 78.1%) vs buprenorphine group (n=62, 51.7%), p< 0.01. In buprenorphine based MOUD, there was no statistically significant difference in the total milligrams prescribed at the beginning of pregnancy compared to the dose at the time of delivery. Comparatively, patients who were prescribed methadone had a statistically significant increase in milligrams prescribed from their dose at the beginning of pregnancy (72.0mg ±43.8) to dose at delivery (106.2mg±50.5, p< 0.01). When comparing maternal and neonatal outcomes across groups, the methadone patients had fewer postpartum follow up visits at 6 weeks,  increased risk of NOWS requiring morphine, and lower birth weights (p < 0.01). See Table 1.

Conclusion: In our study, compared to buprenorphine, patients with OUD  that were treated with methadone needed an increase in dose by delivery. Additionally, they had an increased rate of infants with NOWS, lower birth weights, and less postpartum follow up.