Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Dec;111(12):2115-2128.
doi: 10.1111/add.13462. Epub 2016 Jun 30.

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child

Barbara K Zedler  1 , Ashley L Mann  1 , Mimi M Kim  2 , Halle R Amick  1 , Andrew R Joyce  1 , E Lenn Murrelle  1 , Hendrée E Jones  3   4
Affiliations
Meta-Analysis

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child

Barbara K Zedler et al. Addiction. 2016 Dec.

Abstract

Aims: To assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.

Methods: We searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid-dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random-effects models for each outcome with two or more studies.

Results: Three RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta-analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.

Conclusions: Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

Keywords: Buprenorphine; dependence; fetus; harm; methadone; opioid use disorder; pregnancy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow of paper disposition and study selection
Figure 2
Figure 2
(a) Spontaneous fetal death; (b) fetal/congenital anomalies associated with buprenorphine compared with methadone
Figure 3
Figure 3
Preterm birth associated with buprenorphine compared with methadone
Figure 4
Figure 4
(a) Birth weight; (b) head circumference associated with buprenorphine compared with methadone
Figure 5
Figure 5
(a) Low birth weight; (b) small for gestational age; (c) intrauterine growth restriction associated with buprenorphine compared with methadone
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Substance Abuse and Mental Health Services Administration (SAMHSA) . Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: SAMHSA, 2011 Contract No.: HHS Publication no. (SMA) 11–4658.
    1. Maeda A., Bateman B. T., Clancy C. R., Creanga A. A., Leffert L. R. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology 2014; 121: 1158–65. - PubMed
    1. Gyarmathy V. A., Giraudon I., Hedrich D., Montanari L., Guarita B., Wiessing L. Drug use and pregnancy—challenges for public health. Euro Surveill 2009; 14: 33–36. - PubMed
    1. De Leon G., Jainchill N. Residential therapeutic communities for female substance abusers. Bull NY Acad Med 1991; 67: 277–90. - PMC - PubMed
    1. World Health Organization (WHO) . Guidelines for identification and management of substance use and substance use disorders in pregnancy 2014. Available at: http://www.who.int/substance_abuse/publications/pregnancy_guidelines/en/ (accessed 1 September 2015) (Archived by WebCite® at http://www.webcitation.org/6gOmIM2FB). - PubMed

MeSH terms