Krishnapura Sunaya R, McNeer Elizabeth, Loch Sarah F, Reese Thomas, Dudley Judith, Phillippi Julia C, Wiese Andrew D, Dupont William D, Leech Ashley A, Patrick Stephen W
Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Health Forum. 2025 Apr 27;6(4.11):e251814. doi: 10.1001/jamahealthforum.2025.1814.
Opioid use disorder (OUD) in pregnancy has grown in the US. Buprenorphine, a medication to treat OUD, may improve pregnancy outcomes; however, most pregnant individuals do not receive it. Research evaluating buprenorphine use in pregnancy, its effects on the maternal-infant dyad, and in comparison to no treatment is limited.
To determine if treatment with buprenorphine for opioid use disorder in pregnancy is associated with improved maternal and infant outcomes compared to no treatment among mothers with OUD.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included maternal-infant dyads continuously enrolled in the Tennessee Medicaid program from 20 weeks' estimated gestational age to 6 weeks post partum between 2010 and 2021. Medicaid administrative was linked to birth and death certificates. Data analysis was conducted from April to October 2024.
Buprenorphine use during pregnancy.
Adverse pregnancy outcomes included preterm birth, neonatal intensive care unit (NICU) admission, infant death, severe maternal morbidity (SMM), intensive care unit admission, and maternal death. Logistic regression and propensity scores with overlap weighting were used to calculate adjusted predicted probabilities for adverse outcomes.
Among 14 463 maternal-infant dyads, 7469 (51.6%) received buprenorphine treatment (median [IQR] maternal age, 27 [24-31] years). There was a statistically significant lower rate of adverse pregnancy outcomes among dyads treated with buprenorphine compared to untreated dyads (25.4% vs 30.8%; P < .001); the treatment group also had a lower rate of SMM events (5.4% vs 6.9%; P < .001), preterm births (14.1% vs 20.0%; P < .001), and NICU admissions (15.2% vs 17.2%; P = .001). In adjusted analyses, those with buprenorphine treatment had a 5.1 percentage point (pp; 95% CI, 3.5-6.7 pp) lower probability of any adverse outcomes, including a 1.2 pp (95% CI, 0.4-2.1 pp) lower probability of SMM, 1.7 pp (95% CI, 0.4-2.9 pp) lower probability of NICU admission, and 5.3 pp (95% CI, 4.0-6.6 pp) lower probability of preterm birth. The number needed to treat to avoid an adverse pregnancy outcome was 20.
In this cohort study of pregnant individuals with OUD, buprenorphine treatment was associated with improved outcomes for the mother and infant, underscoring the need to improve access to treatment nationwide.
美国孕期阿片类药物使用障碍（OUD）的情况有所增加。丁丙诺啡是一种用于治疗OUD的药物，可能会改善妊娠结局；然而，大多数孕妇并未使用该药物。评估孕期使用丁丙诺啡及其对母婴二元组的影响以及与未治疗情况相比的研究较为有限。
确定与未接受治疗的患有OUD的母亲相比，孕期使用丁丙诺啡治疗阿片类药物使用障碍是否与改善母婴结局相关。
设计、设置和参与者：这项回顾性队列研究纳入了2010年至2021年期间从估计孕周20周持续登记至产后6周的田纳西州医疗补助计划中的母婴二元组。医疗补助管理数据与出生和死亡证明相关联。数据分析于2024年4月至10月进行。
孕期使用丁丙诺啡。
不良妊娠结局包括早产、新生儿重症监护病房（NICU）入院、婴儿死亡、严重孕产妇发病（SMM）、重症监护病房入院和孕产妇死亡。使用逻辑回归和倾向得分重叠加权法计算不良结局的调整预测概率。
在14463对母婴二元组中，7469对（51.6%）接受了丁丙诺啡治疗（母亲年龄中位数[四分位间距]为27[24 - 31]岁）。与未治疗的二元组相比，接受丁丙诺啡治疗的二元组不良妊娠结局发生率在统计学上显著更低（25.4%对30.8%；P < 0.001）；治疗组的SMM事件发生率也更低（5.4%对6.9%；P < 0.001）、早产发生率更低（14.1%对20.0%；P < 0.001）以及NICU入院率更低（15.2%对17.2%；P = 0.001）。在调整分析中，接受丁丙诺啡治疗的患者出现任何不良结局的概率降低了5.1个百分点（pp；95%置信区间，3.5 - 6.7 pp），包括SMM概率降低1.2 pp（95%置信区间，0.4 - 2.1 pp）、NICU入院概率降低1.7 pp（95%置信区间，0.4 - 2.9 pp）以及早产概率降低5.3 pp（95%置信区间，4.0 - 6.6 pp）。避免不良妊娠结局所需治疗的人数为20。
在这项针对患有OUD的孕妇的队列研究中，丁丙诺啡治疗与母婴结局改善相关，强调了在全国范围内改善治疗可及性的必要性。
