Utilisation de la buprénorphine-naloxone durant la grossesse pour traiter la dépendance aux opiacés Étude de cohorte rétrospective portant sur 30 patientes

Objective To examine the maternal course and neonatal outcomes for women using buprenorphine-naloxone for opioid dependence in pregnancy. Design Retrospective cohort study comparing outcomes for the group of pregnant patients exposed to buprenorphine-naloxone with outcomes for those exposed to other narcotics and those not exposed to narcotics. Setting Northwestern Ontario obstetric program. Participants A total of 640 births in an 18-month period from July 1, 2013, to January 1, 2015. Main outcome measures Maternal outcomes included route and time of delivery, medical and surgical complications, out-of hospital deliveries, change in illicit drug use, and length of stay. Neonatal outcomes included stillbirths, incidence and severity of neonatal abstinence syndrome, birth weight, gestational age, Apgar scores, and incidence of congenital abnormalities. Results Thirty pregnant women used buprenorphine-naloxone for a mean (SD) of 18.8 (11.2) weeks; an additional 134 patients were exposed to other opioids; 476 pregnant women were not exposed to opioids. Maternal and neonatal outcomes were similar among the 3 groups, other than the expected clinically insignificant lower birth weights among those exposed to opioids other than buprenorphine-naloxone. Conclusion Buprenorphine-naloxone appears to be safe for use in pregnancy for opioid-dependence substitution therapy. Transferring a pregnant patient to another opioid agonist that has greater abuse potential might not be necessary. Buprenorphine-naloxone use in pregnancy for treatment of opioid dependence Retrospective cohort study of 30 patients Joe Dooley MD CCFP FCFP Lianne Gerber-Finn MD CCFP Irwin Antone MD CCFP FCFP John Guilfoyle MD CCFP FCFP Brittany Blakelock Jazmyn Balfour-Boehm Wilma M. Hopman MA Naana Jumah MD DPhil FRCSC Len Kelly MD MClSc FCFP FRRM EDITOR’S KEY POINTS • Opioid dependence is common in northwestern Ontario, and buprenorphinenaloxone is widely used in community-based opioid-replacement programs. Although efforts are made to ensure patients use contraception, some women become pregnant while taking buprenorphine-naloxone. Switching to another maintenance agent can present challenges. This study aimed to examine the outcomes of pregnancies exposed to buprenorphine-naloxone. • The authors found that, within the context of an established prenatal program that values opioid tapering to decrease neonatal abstinence syndrome, buprenorphine-naloxone could be safely used in pregnancy. Maternal and neonatal outcomes were generally similar to those of pregnancies exposed to other opioids and those not exposed to opioids. • Pregnancies exposed to buprenorphinenaloxone had significantly larger (normal) birth weights than pregnancies exposed to other narcotics did (P = .004), and more patients taking buprenorphine-naloxone were able to cease illicit opioid use in pregnancy (P < .001). This article has been peer reviewed. Can Fam Physician 2016;62:e194-200