29 - A retrospective comparison of postpartum oral morphine equivalent (OME) requirements in pregnant individuals treated with buprenorphine or methadone for opioid use disorder (OUD)

UF Health Jacksonville, Jacksonville, FL, USA

Purpose
Buprenorphine and methadone are currently recommended as medication-assisted therapy for pregnant individuals with opioid use disorder (OUD). Limited evidence exists surrounding peripartum use of methadone and buprenorphine on postpartum oral morphine equivalent (OME) requirements.
Methods
This single-center, retrospective, IRB-approved review included pregnant individuals with OUD receiving oral buprenorphine or oral methadone upon admission who delivered a neonate from October 2015 to August 2019. The primary outcome was to determine the impact of buprenorphine and methadone on 48-hour postpartum OME requirements. Secondary outcomes included 48-hour postpartum pain scores, and Neonatal Abstinence Syndrome (NAS) outcomes.
Results
There were 53 pregnant individuals on buprenorphine (median dose 16mg) and 212 on methadone (median dose 95mg). Buprenorphine-maintained pregnant individuals, compared to methadone, had lower 48-hour postpartum total median OME requirements (12.5 vs 68.9, p=0.001) and 48-hour postpartum median pain scores (3.0 vs 4.0, p=0.003). Both methadone and buprenorphine patients undergoing vaginal delivery required lower OME (5.5 vs 34.2, p=0.009) than patients undergoing cesarean delivery (138.5 vs 128.9, p>0.05). Neonates born to buprenorphine mothers had higher birthweight (3090mg vs 2830mg, p=0.03) and head circumference (33.9cm vs 33.0cm, p=0.002) compared to methadone-maintained mothers. NAS incidence and duration of treatment was similar amongst both groups - (23 vs 90 neonates, p=0.90) and (11.8 days vs 15.0 days, p=0.12), respectively.
Conclusions
Pregnant individuals on buprenorphine for OUD may require lower postpartum opioids, especially following vaginal delivery, compared to methadone-maintained pregnant individuals. Neonates with in-utero exposure to buprenorphine may have higher head circumference and birthweight.