Meta-analysis shows methadone exposure linked to higher NAS incidence and treatment needs versus buprenorphine in pregnant women
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Key Takeaway
Note higher NAS incidence and treatment needs with methadone versus buprenorphine-naloxone in pregnant women.
This systematic review and meta-analysis examined the outcomes of buprenorphine-based therapies versus methadone in pregnant women with opioid use disorder. The pooled analysis included 5524 participants and assessed neonatal abstinence syndrome incidence, pharmacologic treatment for NAS, and birth weight as primary and secondary outcomes. The study did not report adverse events, discontinuations, or tolerability data.
Regarding neonatal abstinence syndrome, infants exposed to methadone demonstrated a higher incidence compared with those exposed to buprenorphine-naloxone. The effect size was 0.44 with a 95% CI of 0.25-0.75 and a P value less than 0.01. Similarly, infants exposed to methadone required more pharmacologic treatment for NAS than those exposed to buprenorphine-naloxone, though the specific effect size for this outcome was not reported.
For birth weight, infants exposed to buprenorphine showed slightly higher weights than those exposed to methadone. The effect size was 0.17 kg with a 95% CI of -0.14 to 1.49 and a P value of 0.049. The authors caution that while these findings suggest potential benefits of buprenorphine-based therapies, the lack of reported safety data and the observational nature of some underlying studies limit definitive conclusions regarding long-term outcomes or rare adverse events.
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View Original Abstract ↓
BACKGROUND AND AIMS: Opioid addiction poses a significant challenge to both the health of mothers and the outcomes for their newborns. Treatments based on buprenorphine offer a proven strategy for addressing opioid dependence among pregnant women. Various studies have examined the effectiveness of buprenorphine treatments versus methadone, revealing several potential advantages of buprenorphine for the outcomes of newborns. This systematic review sought to clarify the benefits and risks associated with buprenorphine therapy.
METHODS: The PubMed, Web of Science and Scopus databases were searched with keywords for qualifying papers published before February 2025. Mean differences (MD) and 95% confidence intervals (CIs) were calculated for continuous data, while pooled proportions were estimated for categorical variables. Interstudy heterogeneity and publication bias were assessed using I and Egger's tests with Meta-Essential software analyses.
RESULTS: The initial database search identified 2019 studies. Following a screening process based on inclusion criteria, 38 studies were selected for data extraction. The number of participants involved in all included studies was 5524. The results indicated that infants exposed to methadone had a higher incidence of neonatal abstinence syndrome (NAS) and required more pharmacologic treatment compared with those exposed to buprenorphine-naloxone (0.44, 95% CI = 0.25-0.75, P < 0.01). Additionally, infants exposed to buprenorphine had slightly higher birth weights than those exposed to methadone (0.17 kg, 95% CI = -0.14 to 1.49, P = 0.049), which might be linked to a greater need for NAS treatment.
CONCLUSION: Compared with methadone in treating opioid use disorder during pregnancy, buprenorphine-based therapies, buprenorphine-naloxone in particular, have demonstrated greater efficacy in enhancing neonatal outcomes.
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