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Review
. 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

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Free PMC article
Review

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. .
Free PMC article

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.

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

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