Background
Gestational opioid use/misuse is escalating in the United States; however, little
is understood about the fetal effects of medications used to treat maternal opioid
use disorders.
Objective
The purpose of this study was to determine the effect of maternal buprenorphine administration
on longitudinal fetal neurobehavioral development.
Study Design
Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment
facility with generally uncomplicated pregnancies underwent fetal monitoring for 60
minutes at times of trough and peak maternal buprenorphine levels. Data were collected
at 24, 28, 32, and 36 weeks gestation. Fetal neurobehavioral indicators (ie, heart
rate, motor activity, and their integration [fetal movement–fetal heart rate coupling])
were collected via an actocardiograph, digitized and quantified. Longitudinal data
analysis relied on hierarchic linear modeling.
Results
Fetal heart rate, heart rate variability, and heart rate accelerations were significantly
reduced at peak vs trough maternal buprenorphine levels. Effects were significant
either by or after 28 weeks gestation and tended to intensify with advancing gestation.
Fetal motor activity and fetal movement–fetal heart rate coupling were depressed from
peak to trough at 36 weeks gestation. Polysubstance exposure did not significantly
affect fetal neurobehavioral parameters, with the exception that fetuses of heavier
smokers moved significantly less than those of lighter smokers at 36 weeks gestation.
By the end of gestation, higher maternal buprenorphine dose was related to depression
of baseline fetal cardiac measures at trough.
Conclusion
Maternal buprenorphine administration has acute suppressive effects on fetal heart
rate and movement, and the magnitude of these effects increases as gestation progresses.
Higher dose (≥13 mg) appears to exert greater depressive effects on measures of fetal
heart rate and variability. These findings should be balanced against comparisons
to gestational methadone effects, relatively good outcomes of buprenorphine-exposed
infants, and recognition of the benefits of medication-assisted treatment for pregnant
women with opioid use disorders in optimizing pregnancy outcomes.
Key words
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Article Info
Publication History
Published online: February 07, 2017
Accepted:
January 31,
2017
Received in revised form:
November 4,
2016
Received:
September 19,
2016
Footnotes
Dr King is now affiliated with the Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas.
Supported by National Institutes of Health/National Institute of Drug Abuse RO1 DA013689 . Study medication was provided by Indivior, who had no role in study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
Dr Jansson was a paid consultant for Chiesi, Inc.
Clinical Trials Registry name and registration number: Fetal and Infant Effects of Maternal Buprenorphine Treatment NCT15671079 https://clinicaltrials.gov/ct2/show/NCT01561079?term=jansson&rank=12.
Cite this article as: Jansson LM, Velez M, McConnell K, et al. Maternal buprenorphine treatment and fetal neurobehavioral development. Am J Obstet Gynecol 2017;216:529.e1-8.
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