New research published in JAMA Health Forum indicates that using buprenorphine to treat opioid use disorder (OUD) during pregnancy is associated with better outcomes for both mothers and their infants. The study’s authors emphasize the critical need to expand access to buprenorphine treatment across the United States.

The Growing Concern of OUD in Pregnant Women

The prevalence of OUD among pregnant women has been steadily increasing. Current data reveals that 8.2 out of every 1,000 deliveries in the U.S. are affected by this condition. OUD during pregnancy poses meaningful risks, leading to adverse health outcomes for both the mother and the infant, including overdose, infection, fetal growth restriction, preterm birth, and even death.

Despite recommendations for buprenorphine use, many pregnant women who could benefit from this treatment do not receive it.

Expert Insights on Treatment Barriers

Stephen Patrick, MD, senior author of the study, highlighted the challenges pregnant women face in accessing treatment for OUD:

Nationwide, pregnant women face ample barriers to getting treatment for opioid use disorder—and as a result, we’ve seen increases in overdose deaths before and after they deliver their babies.

Stephen Patrick, MD, Vanderbilt University

Dr. Patrick also noted the surprising lack of comparative data between buprenorphine treatment and no treatment for OUD in pregnant women.

Study Details: buprenorphine vs. No Treatment

Researchers from Vanderbilt University and Emory University’s rollins School of Public Health conducted a study to evaluate the impact of buprenorphine treatment on maternal and infant outcomes compared to no treatment. The study utilized data from Tennessee Medicaid records between 2010 and 2021, linked to birth and death certificates.

Study Participants and Outcomes

• The study included 14,463 maternal-infant dyads, with 7,469 receiving buprenorphine treatment.
• Participants where enrolled in the Tennessee medicaid programme from 20 weeks estimated gestational age to 6 weeks postpartum.
• Pregnant women aged 15 to 44 with an OUD diagnosis or a filled buprenorphine prescription during pregnancy were included.
• Primary outcomes assessed included severe maternal morbidity, ICU admission, maternal death, preterm birth, NICU admission, and infant death.

Key Findings: Improved Outcomes with Buprenorphine

The study revealed that the yearly rate of adverse pregnancy outcomes increased from 27% to 31.6%.Adverse maternal outcomes rose from 4.9% to 5.6%, while adverse infant outcomes increased from 24.5% to 29.7%. Though, among patients treated with buprenorphine, only 25.4% experienced adverse pregnancy outcomes, compared to 30.8% in the untreated group. Rates of severe maternal morbidity and NICU admissions were also lower in the treatment group.

While there was no statistically significant difference in ICU admission, maternal death, or infant death rates between the groups, the treatment group did experience higher rates of neonatal opioid withdrawal syndrome.

Study Limitations

The researchers acknowledged several limitations, including:

• Potential for residual confounding.
• Misclassification bias in primary data sources.
• Potential bias due to the lack of observed medication administration.
• Limited generalizability beyond Tennessee or non-Medicaid populations.
• Possibility of diagnoses occurring before pregnancy.

Call to Action: Expanding Treatment Access

Sunaya Krishnapura, a graduating medical student at Vanderbilt University School of Medicine and an author of the study, emphasized the disparities in access to buprenorphine:

Disparities in access to buprenorphine significantly affect vulnerable populations, including pregnant women. Our findings underscore the urgent need for policies that expand treatment access in the United States to ensure a healthy pregnancy and future for mothers and infants.

Sunaya Krishnapura, Vanderbilt University School of Medicine