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Opioid Detoxification During Pregnancy: A Systematic Review
Mishka Terplan1, Hollis J Laird, Dennis J Hand
1Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, Richmond, Virginia; the Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Obstetrics & Gynecology, Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, Hawaii; the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Department Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics, Gynecology & Reproductive Services, University of Vermont, Burlington, Vermont.
Opioid detoxification during pregnancy shows low completion and high relapse rates. Fetal loss rates were similar between women who did and did not undergo detoxification, suggesting it is not a recommended intervention.
Area of Science:
- Obstetrics and Gynecology
- Addiction Medicine
- Neonatal Health
Background:
- Opioid use disorder in pregnancy presents complex challenges for maternal and neonatal care.
- Treatment options for pregnant individuals with opioid use disorder require careful consideration of risks and benefits.
- Opioid detoxification is one approach, but its efficacy and safety during pregnancy need systematic evaluation.
Purpose of the Study:
- To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy.
- To synthesize evidence on the effectiveness and safety of detoxification interventions for pregnant women with opioid use disorder.
- To inform clinical practice guidelines regarding opioid use disorder treatment in pregnancy.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, PsycINFO, EMBASE, Cochrane, ClinicalTrials.gov) from 1966 to 2016.
- English-language studies reporting outcomes of opioid detoxification in pregnant women were included; non-original research and studies lacking outcome data were excluded.
- Study quality and bias were assessed using established tools (Cochrane Collaboration, U.S. Preventive Services Task Force).
Main Results:
- Fifteen studies including 1,997 participants (1,126 detoxified) were analyzed; study quality was generally fair to poor.
- Detoxification completion rates varied widely (9-100%), as did illicit drug relapse rates (0-100%).
- Fetal loss rates were comparable between women who underwent detoxification (1.2%) and those who did not (2.0%).
Conclusions:
- Current evidence does not support opioid detoxification as a recommended treatment for pregnant individuals due to low completion rates and high relapse.
- Limited data exist on the long-term maternal and neonatal effects of detoxification beyond delivery.
- Further research is needed to establish safe and effective interventions for opioid use disorder in pregnancy.
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