Abdelwahab M, Petrich M, Wang H, Walker E, Cleary EM, Rood KM. Risk factors for preterm birth among gravid individuals receiving buprenorphine for opioid use disorder.
Am J Obstet Gynecol MFM 2022;
4:100582. [PMID:
35123110 DOI:
10.1016/j.ajogmf.2022.100582]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/14/2022] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE
Pregnancies complicated by opioid use disorder (OUD) are at an increased risk for preterm birth (PTB), defined as delivery <37 weeks gestation. Limited literature is available on prevalence and risk factors for PTB in pregnancies complicated by OUD maintained on buprenorphine Therefore, we sought to determine rate of PTB and risk factors for PTB in this population.
STUDY DESIGN
We performed a retrospective cohort study of pregnant individuals with singleton gestation receiving buprenorphine for OUD, who delivered at a tertiary academic medical center between 7/1/2013 and 6/30/2018. Individuals who had at least three visits in our co-located clinic were included in analysis. Patients were divided into 2 groups, those delivered <37 weeks gestation were included in preterm group, while patient delivered ≥ 37 weeks were included in term group. We defined "supplements to buprenorphine" to include any illicit drugs found on antepartum urine toxicology. Variables evaluated as potential risk factors for PTB included medical and infectious comorbidities as well as illicit polysubstance use.
RESULTS
The overall PTB rate in this cohort was 22.7% (115/507). There was a non-significant trend towards decrease in overall PTB and provider-initiated PTB rate over study period. No differences found in spontaneous PTB or PTB< 34 weeks. There were no differences in use of tobacco, alcohol, number of prenatal visits or gestational age when prenatal care started between those who delivered preterm compared to term. Individuals with PTB in the index pregnancy were more likely to have history of PTB compared to those with term delivery (73% vs 16%; P<.01). No medical or infectious comorbidity nor any specific supplement increased risk of PTB. Among individuals using 0, 1, 2, or 3 or more illicit supplements in addition to confirmed buprenorphine for OUD, the PTB rate was 27.4% (reference), 18.0% (P=0.09), 18.1% (P=0.44), and 15.8% (P=0.77), respectively.
CONCLUSION
The PTB rate among individuals using buprenorphine for OUD (22.7%) is higher than national average but lower than the reported PTB rate in individuals using methadone for MOUD.. No medical or infectious comorbidity or use of additional illicit substances increased the risk of PTB.
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