Researchers from the Department of Obstetrics and Gynecology at the University of Tennessee Medical Center have found that the detoxification of opiate-addicted pregnant women does not appear to be harmful, and that the rate of neonatal abstinence syndrome (NAS) can be reduced with continued long-term behavioral health follow-up. The findings were published in the American Journal of Obstetrics and Gynecology.
While current obstetric practice is to not withdraw opiate-addicted women from opioids during pregnancy for fear of an increased risk of stillbirth, fetal distress, premature labor, and a high rate of relapse, these concerns “primarily stem from two 1970s case reports that suggested fetal harm from detox. [However], several studies since these two publications have reported on detox during pregnancy with minimal fetal harm identified,” wrote Jennifer Bell, MD, and colleagues.
To evaluate the safety of full opiate detoxification during pregnancy in a large number of patients, the researchers retrospectively analyzed data collected during ongoing prenatal care of pregnant women addicted to opioids at the maternal-fetal medicine (MFM) department at the University of Tennessee Medical Center in Knoxville.
The women underwent detoxification in 4 different groups: (1) acute detox of incarcerated patients using antiemetic agents, anti-diarrheal drugs, and clonidine to treat symptoms of withdrawal, but no opiates (n=108); (2) inpatient detox in 5 to 8 days using buprenorphine with intense outpatient follow-up management (n=23); (3) inpatient detox in 5-8 days using buprenorphine without intense outpatient follow-up management (n=77); and (4) slow outpatient buprenorphine detox over 8-16 weeks (n=93).
The researchers analyzed pregnancy complications including fetal demise and preterm labor, and also assessed the rates of newborns treated for NAS in each group.
Over 5.5 years, 301 opiate-addicted patients were fully detoxed during pregnancy, with no adverse fetal outcomes related to detox identified.
Of the 301 women, 94 (31%) delivered newborns treated for NAS. Group 1, patients acutely detoxed while incarcerated, had an 18.5% rate of NAS; group 2, inpatient detox with intense outpatient follow-up management, had a 17.4% rate of NAS; group 3, inpatient detox without intense outpatient follow-up management, had a 70.1% rate of NAS; and group 4, slow outpatient buprenorphine detox, had a 17.2% rate of NAS. The researchers noted that the rate of NAS is high primarily when no continued long-term follow-up occurs, showing the necessity and importance of intense behavioral health follow-up.
“These data highly suggest that detoxification from opiates during pregnancy is not harmful,” the researchers wrote. “Whether this treatment management should become common practice in obstetrics will take further study as to whether detoxification/long-term behavioral health programs can be universally developed, implemented, and funded.”
The researchers also emphasized that “the rate of NAS can also be reduced if continued long-term behavioral health follow-up occurs once a patient is drug free.”