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
. 2018 May;131(5):803-814.
doi: 10.1097/AOG.0000000000002562.

Opioid Detoxification During Pregnancy: A Systematic Review

Mishka Terplan  1 , Hollis J Laird, Dennis J Hand, Tricia E Wright, Ashish Premkumar, Caitlin E Martin, Marjorie C Meyer, Hendrée E Jones, Elizabeth E Krans
Affiliations

Opioid Detoxification During Pregnancy: A Systematic Review

Mishka Terplan et al. Obstet Gynecol. 2018 May.

Abstract

Objective: To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy.

Data sources: PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016.

Methods of study selection: English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale.

Tabulation, integration, and results: Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9-100%) and illicit drug relapse (0-100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]).

Conclusions: Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Figures

Fig. 1
Fig. 1. Flow diagram
Terplan. Opioid Detoxification During Pregnancy. Obstet Gynecol 2018.
See this image and copyright information in PMC

Comment in

  • Opioid Detoxification During Pregnancy: A Systematic Review.
    Dashe JS, Nelson DB, Stewart RD, Adhikari EH, Roberts SW, Wendel GD Jr. Dashe JS, et al. Obstet Gynecol. 2018 Oct;132(4):1061. doi: 10.1097/AOG.0000000000002886. Obstet Gynecol. 2018. PMID: 30247339 No abstract available.
  • In Reply.
    Terplan M, Laird HJ, Hand DJ, Wright TE, Premkumar A, Martin CE, Meyer MC, Jones HE, Krans EE. Terplan M, et al. Obstet Gynecol. 2018 Oct;132(4):1061-1062. doi: 10.1097/AOG.0000000000002885. Obstet Gynecol. 2018. PMID: 30247340 No abstract available.

References

    1. American Society of Addiction Medicine (ASAM) National practice guideline for the use of medications in the treatment of addiction involving opioid use. Available at: https://www.asam.org/docs/default-source/practice-support/guidelines-and.... Retrieved January 26, 2018. - PMC - PubMed
    1. World Health Organization (WHO) Community management of opioid overdose. Available at: http://apps.who.int/iris/bit-stream/10665/137462/1/9789241548816_eng.pdf. Retrieved January 26, 2018.
    1. Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e81–94. - PubMed
    1. Rementeriá JL, Nunag NN. Narcotic withdrawal in pregnancy: stillbirth incidence with a case report. Am J Obstet Gynecol. 1973;116:1152–6. - PubMed
    1. Zuspan FP, Gumpel JA, Mejia-Zelaya A, Madden J, Davis R. Fetal stress from methadone withdrawal. Am J Obstet Gynecol. 1975;122:43–6. - PubMed

Publication types

MeSH terms