Heil Co-Authors NEJM Study on Effects of Treatment on Babies of Opioid-Dependent Moms
Release Date: 12-10-2010
(This news release was adapted from a release produced by the Media Relations and Public Affairs Office at the Johns Hopkins University School of Medicine.)
Using buprenorphine instead of methadone – the current standard of care – to treat opioid-dependent pregnant women may result in healthier babies, suggests new findings published in the Dec. 9 New England Journal of Medicine (NEJM) by an international research team including University of Vermont Research Associate Professor of Psychiatry and Psychology Sarah Heil, Ph.D.
Prenatal exposure to methadone is associated with a neonatal abstinence syndrome (NAS). Caused by a fetus' exposure to heroin and/or prescription opioids in the womb, NAS is characterized by central nervous system hyperirritability and autonomic nervous system dysfunction and often requires medication and extended hospitalization. Buprenorphine, which is an alternative treatment for opioid dependence, has not been extensively studied in pregnancy. The team's research revealed that babies born to mothers taking buprenorphine to counter heroin and/or prescription opioid addiction needed less morphine to treat drug withdrawal symptoms and spent half as much time in the hospital after delivery compared to babies born to mothers taking methadone.
Heil and colleagues at eight sites around the world conducted a double-blind, randomized controlled trial entitled The Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, which compared buprenorphine and methadone in the comprehensive care of 175 opioid-dependent pregnant women, ages 18 to 40, who were six to 30 weeks pregnant.
Although not specifically FDA-approved for such use, the accepted and recommended treatment for opioid dependence during pregnancy is methadone, a synthetic opiate. Patients – including pregnant women – are prescribed methadone in an effort to keep them away from dangerous and illegal street drugs, including heroin, and the risky life issues associated with procuring and taking illegal drugs. Buprenorphine, a newer compound, is comparable to methadone and both create similar side effects and outcomes for the mother.
Study participants received extensive prenatal and postnatal care and monitoring. Their care plans included psychological evaluations, blood work, sonograms, daily clinic visits, weekly questionnaires, a non-stress test, case management, and group and individual counseling. The mothers and newborns also were monitored for 28 days following delivery.
"Babies prenatally exposed to buprenorphine had significantly better outcomes compared to babies exposed to methadone," said Heil. "These results support the use of buprenorphine as the treatment of choice for opioid-dependent pregnant women."
UVM co-investigators on the study, which was supported by the National Institute on Drug Abuse, include: John Brooklyn, M.D., clinical assistant professor of family medicine; Stephen Higgins, Ph.D., professor of psychiatry and psychology; Anne Johnston, M.D., associate professor of pediatrics; Marjorie Meyer, M.D., associate professor of obstetrics, gynecology and reproductive sciences; and Stacey Sigmon, Ph.D., research associate professor of psychiatry and psychology.