Association between buprenorphine dose and outcomes among pregnant persons with opioid use disorder

Opioid use disorder contributes to maternal morbidity and mortality in the United States. Little is known about how the patterns of buprenorphine dose and duration throughout pregnancy may affect neonatal and postpartum outcomes.

To determine the associations between trajectories of buprenorphine utilization and dose during pregnancy on maternal and neonatal health outcomes.

Retrospective cohort study among 2925 pregnant persons with opioid use disorder, followed from the estimated start date of pregnancy through 90 days after delivery. We used administrative healthcare data from Medicaid-enrolled individuals to assess buprenorphine dose and use and maternal (postpartum buprenorphine continuation and overdose) and neonatal (low birthweight, neonatal abstinence syndrome (NAS)) outcomes. Group-based trajectory modelling was used to identify trajectories of buprenorphine dose and use during pregnancy. Weighted multivariable logistic regression assessed the association between buprenorphine trajectories and outcomes.

We identified 8 trajectories of buprenorphine utilization and dose during pregnancy. Regression analyses found that high doses of buprenorphine and a longer duration of buprenorphine use during pregnancy was associated with higher odds of postpartum buprenorphine continuation and reduced rates of overdose. Higher doses and longer duration of buprenorphine treatment were not associated with an increase in NAS or term low birth weight, relative to moderate or low doses or shorter treatment duration.

A longer duration and higher dose of buprenorphine treatment during pregnancy were associated with improved odds of postpartum buprenorphine continuation and were not associated with adverse neonatal outcomes.