Buprenorphine plus naloxone could be safe alternative for OUD in pregnancy

Researchers of a new study published in JAMA sought to investigate the neonatal and maternal safety of buprenorphine plus naloxone compared with buprenorphine only in pregnant patients with OUD.

Outcomes comparisons revealed a reduced risk for neonatal abstinence syndrome in those receiving buprenorphine plus naloxone, which also demonstrated a modestly lower risk of small for gestational age and/or admission to a neonatal intensive care unit.

The sample of patients included 8,695 Medicaid beneficiaries with live births between 2000 and 2018. A total of 3,369 patients received the combination treatment during the first 3 months of pregnancy, while 5,326 patients—some of whom switched from the two-drug approach—received buprenorphine in the first trimester.

The maternal morbidity rate among the pregnant patients who underwent combination therapy was 2.6% versus 2.9% for their counterparts who received buprenorphine alone. No between-group disparities were documented for major congenital malformations, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery.

The findings suggest that buprenorphine plus naloxone is a safe alternative OUD intervention for women in early pregnancy, although buprenorphine by itself is also safe.