Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

This cohort study compared neonatal and maternal outcomes in pregnant individuals with opioid use disorder (OUD) treated with buprenorphine versus methadone, using Medicaid data from 2000–2018. The study included 10,704 buprenorphine exposed and 4,387 methadone exposed pregnancies in early pregnancy, with similar proportions in late pregnancy. Key findings revealed that buprenorphine was associated with significantly lower risks of neonatal abstinence syndrome (52.0% vs. 69.2%; adjusted relative risk [RR] 0.73), preterm birth (14.4% vs. 24.9%; RR 0.58), small size for gestational age (12.1% vs. 15.3%; RR 0.72), and low birth weight (8.3% vs. 14.9%; RR 0.56). Maternal outcomes, including cesarean section rates and severe complications, were similar between groups. The results suggest that buprenorphine may offer safer neonatal outcomes than methadone for OUD treatment during pregnancy, supporting its use as a preferred therapy.

This cohort study compared neonatal and maternal outcomes in pregnant individuals with opioid use disorder (OUD) treated with buprenorphine versus methadone, using Medicaid data from 2000–2018. The study included 10,704 buprenorphine exposed and 4,387 methadone exposed pregnancies in early pregnancy, with similar proportions in late pregnancy. Key findings revealed that buprenorphine was associated with significantly lower risks of neonatal abstinence syndrome (52.0% vs. 69.2%; adjusted relative risk [RR] 0.73), preterm birth (14.4% vs. 24.9%; RR 0.58), small size for gestational age (12.1% vs. 15.3%; RR 0.72), and low birth weight (8.3% vs. 14.9%; RR 0.56). Maternal outcomes, including cesarean section rates and severe complications, were similar between groups. The results suggest that buprenorphine may offer safer neonatal outcomes than methadone for OUD treatment during pregnancy, supporting its use as a preferred therapy.