From the Department of Obstetrics and Gynecology, Quillen College of Medicine, East Tennessee State University, Johnson City.
South Med J. 2020 Nov;113(11):553-558. doi: 10.14423/SMJ.0000000000001164.
Many addicted pregnant patients receiving buprenorphine medication-assisted therapy (MAT) wish to discontinue this medication while pregnant. This study was undertaken to determine whether outpatient detoxification from buprenorphine during pregnancy is safe and effective when confirmed with postdetoxification urine drug screens (UDSs).
This case series reports the maternal and neonatal outcomes for 21 patients who ended MAT with buprenorphine while pregnant. A retrospective chart review of both maternal and newborn electronic medical records was performed to obtain results. Newborn neonatal abstinence syndrome (NAS) diagnosis, need for morphine, maternal safety and fetal/newborn complications were assessed. Maternal sobriety was documented with UDSs at the time of admission for delivery. Umbilical cord blood also was assessed for substances of abuse. An additional 182 pregnant women who lowered their buprenorphine doses but did not decide to end MAT were assessed via routine quality assurance methods.
None of the women who stopped buprenorphine during their pregnancy as confirmed by UDSs and umbilical cord sampling delivered neonates who had NAS. Eleven patients ended MAT with medical assistance and 10 ended MAT without medical assistance. No overdoses were reported for the 182 additional pregnant patients who indicated an intention to taper buprenorphine dosage while pregnant but who did not decide to end MAT; the neonatal benefits were obtained without any identified maternal harm.
The neonates of pregnant women enrolled in an outpatient buprenorphine MAT tapering program who are able to completely stop taking buprenorphine (as documented by negative urinary drug screen) are very unlikely to have NAS. Further research will be important.
许多接受丁丙诺啡药物辅助治疗（MAT）的成瘾孕妇希望在怀孕期间停止使用该药物。本研究旨在确定在确认产后尿液药物筛查（UDS）后，门诊丁丙诺啡戒毒是否安全有效。
本病例系列报告了 21 名在怀孕期间结束丁丙诺啡 MAT 的患者的母婴结局。对母亲和新生儿的电子病历进行回顾性图表审查，以获取结果。评估新生儿戒断综合征（NAS）诊断、吗啡需求、母亲安全性和胎儿/新生儿并发症。在分娩时入院时通过 UDS 记录母亲的清醒情况。还评估了脐带血中的滥用物质。通过常规质量保证方法评估了另外 182 名降低丁丙诺啡剂量但未决定结束 MAT 的孕妇。
在 UDS 和脐带采样确认停止丁丙诺啡的孕妇中，没有新生儿出现 NAS。11 名患者在医疗协助下结束 MAT，10 名患者在无医疗协助下结束 MAT。没有报告 182 名额外孕妇的过量用药情况，这些孕妇表示打算在怀孕期间减少丁丙诺啡剂量，但不决定结束 MAT；在没有任何明确的母亲伤害的情况下，获得了新生儿的益处。
能够完全停止服用丁丙诺啡（通过阴性尿液药物筛查证明）的接受门诊丁丙诺啡 MAT 减量计划的孕妇的新生儿不太可能出现 NAS。进一步的研究将是重要的。
