Pregnancy

Uptake of buprenorphine in pregnancy increases after updated guidelines

Data derived from Nguemeni Tiako MJ, et al. Am J Obstet Gynecol. 2022;doi:10.1016/j.ajog.2022.05.041.

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Following updates to guidelines for the treatment of opioid use disorder, pregnant women have increasingly used buprenorphine compared to non-pregnant women.

In light of the increase in prenatal opioid use disorder (OUD), in August 2017 ACOG and the American Society of Addiction Medicine (ASAM) expanded their guidelines for the treatment of OUD during pregnancy to include buprenorphine. Until then, only methadone was recommended by these organizations for the treatment of pregnant women with OUD.

Data taken from Nguemeni Tiako MJ, et al. Am J Obstet Gynecol. 2022; doi:10.1016/j.ajog.2022.05.041.

“Yet the evidence shows that pregnant patients receive medication for OUD at low rates and face barriers when seeking treatment (particularly with regard to access to buprenorphine), and little of obstetricians-gynecologists are authorized to prescribe buprenorphine”, Max Jordan Nguemeni Tiako, MD, MS, a resident physician at Brigham and Women’s Hospital in Boston, and his colleagues wrote.

Nguemeni Tiako and colleagues used MarketScan (IBM Watson Health) complaints and business encounter data to compare changes in buprenorphine use between pregnant and non-pregnant women between 2014 and 2019.

The sample included 86,522 women aged 15-45, of whom 2,137 (2.5%) had been pregnant at least once. Of these, the mean age at baseline was 27.6 years (standard deviation [SD], 6 years). The mean age at baseline among nonpregnant women was 30.9 years (SD, 7.9 years). Most patients (n = 70,704; 81.7%) lived in urban areas.

Compared to non-pregnant women, pregnant women experienced a 2.1 percentage point (95% CI, 1-3.2) increase in buprenorphine use after the guideline change. This equates to a 12% increase over the period prior to the guideline change.

A sensitivity analysis excluding 2017 demonstrated a similar increase in buprenorphine use among pregnant women (2.3 percentage points; 95% CI, 0.8-3.7).

Among women who had never received treatment for OUD, the rate of buprenorphine initiations increased from 12 to 13 initiations per 100 person-years in non-pregnant women and from 17 to 21 initiations per 100 person-years. people in pregnant women.

“Our results suggest that the 2017 ACOG-ASAM OUD guidelines resulted in increased uptake of buprenorphine in pregnant women with OUD compared to non-pregnant women,” Nguemeni Tiako and colleagues wrote. “Professional society guidelines could be an effective tool in addressing the current epidemic of drug overdoses in the United States.”