Opioid Detoxification during Pregnancy: Systematic Review and Meta-Analysis of Maternal and Neonatal Outcomes [11R]. (May 2018)

• Record Type: Journal Article
• Authors: Wang, Michelle; Kuper, Spencer; Sims, Brian; Paddock, Cayce; Williams-Glass, Terri; Harper, Lorie
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000533261.35229.25
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: While maintenance therapy for opioid use disorders is the standard of care, the expanding opioid epidemic has renewed interest in maternal detoxification. We aim to assess the efficacy and safety of detoxification from opioids compared to maintenance with methadone or buprenorphine to treat opioid-dependent pregnant women. METHODS: We searched PubMed, Embase, the Cochrane Library andClinicalTrials.gov from inception to June 2017. We included randomized controlled trials or cohort studies that compared detoxification with maintenance for treating opioid-dependent pregnant women. We sought to find any studies with outcomes data for maternal abstinence at time of delivery, neonatal abstinence syndrome (NAS), stillbirth, and preterm birth (PTB). Pooled relative risks (RRs) were calculated using a random-effects model. Heterogeneity was assessed using the chi-squared test for heterogeneity and the I2 test. Publication bias was assessed using funnel plots and Harbord test. RESULTS: Three cohort studies met inclusion criteria; these studies compared an inpatient taper to inpatient or outpatient maintenance therapy. These eligible studies included a total of 235 women with opioid use disorder in pregnancy. Maternal detoxification was associated with increased risk of relapse (RRs 1.91, 95% confidence interval (CI) = 1.14-3.21). However, no treatment differences were observed for rates of NAS (RRs=0.99, 95% CI = 0.38-2.53) or PTB (RRs = 0.39, 95% CI = 0.10-1.60). CONCLUSION: Our findings suggest there is an increased risk of relapse with detoxification compared with maintenance; however, we found detoxification does not increase the risk of PTB or NAS. Further studies should confirm our findings and explore mechanisms to fight the opioid epidemic.