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Fetal assessment before and after dosing with buprenorphine or methadone
Author(s) -
Salisbury Amy L.,
Coyle Mara G.,
O'Grady Kevin E.,
Heil Sarah H.,
Martin Peter R.,
Stine Susan M.,
Kaltenbach Karol,
Weninger Manfred,
Jones Hendrée E.
Publication year - 2012
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2012.04037.x
Subject(s) - buprenorphine , methadone , dosing , medicine , fetus , opioid , anesthesia , pregnancy , gestation , heart rate , obstetrics , blood pressure , receptor , biology , genetics
Aim To determine pre‐ and post‐dosing effects of prenatal methadone compared to buprenorphine on fetal wellbeing. Design A secondary analysis of data derived from the M aternal O pioid T reatment: H uman E xperimental R esearch ( MOTHER ) study, a double‐blind, double‐dummy, randomized clinical trial. Setting Six U nited S tates sites and one E uropean site that provided comprehensive opioid‐dependence treatment to pregnant women. Participants Eighty‐one of the 131 opioid‐dependent pregnant women completing the MOTHER clinical trial, assessed between 31 and 33 weeks of gestation. Measurements Two fetal assessments were conducted, once before and once after study medication dosing. Measures included mean fetal heart rate ( FHR ), number of FHR accelerations, FHR reactivity in the fetal non‐stress test ( NST ) and biophysical profile ( BPP ) score. Findings Significant group differences were found for number of FHR accelerations, non‐reactive NST and BPP scores (all P s < 0.05). There were no significant group differences before time of dosing. Significant decreases (all P s < 0.05) occurred from pre‐ to post‐dose assessment for mean FHR , FHR accelerations, reactive NST and fetal movement. The decrease in accelerations and reactive NST were significant only for fetuses in the methadone group, and this resulted in a significantly lower likelihood of a reactive NST compared to fetuses in the buprenorphine group. Conclusion Buprenorphine compared with methadone appears to result in less suppression of mean fetal heart rate, fetal heart rate reactivity and the biophysical profile score after medication dosing and these findings provide support for the relative safety of buprenorphine when fetal indices are considered as part of the complete risk–benefit ratio.