Maternal buprenorphine treatment and fetal neurobehavioral development

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Pharmacology

Background:

• Gestational opioid use is increasing in the U.S.
• Limited understanding of fetal effects from medications for maternal opioid use disorders.

Purpose of the Study:

• To determine the effect of maternal buprenorphine on longitudinal fetal neurobehavioral development.

Main Methods:

• Fetal monitoring (heart rate, motor activity, movement-heart rate coupling) in 49 buprenorphine-maintained pregnant women.
• Data collected at 24, 28, 32, and 36 weeks gestation during trough and peak maternal buprenorphine levels.
• Longitudinal data analyzed using hierarchic linear modeling.

Main Results:

• Buprenorphine reduced fetal heart rate, variability, and accelerations at peak vs. trough levels, becoming significant by 28 weeks gestation.
• Fetal motor activity and movement-heart rate coupling were depressed at 36 weeks gestation.
• Higher maternal buprenorphine dose correlated with depressed fetal cardiac measures at trough by end of gestation.

Conclusions:

• Maternal buprenorphine has acute, dose-dependent suppressive effects on fetal neurobehavior that increase with gestational age.
• Findings should be weighed against benefits of medication-assisted treatment for pregnant women with opioid use disorders.
• Consideration of methadone effects and positive infant outcomes with buprenorphine is important.