The treatment of opioid dependence during pregnancy has historically consisted of either medication-assisted withdrawal or maintenance treatment with methadone. Buprenorphine maintenance treatment is emerging as a treatment during pregnancy with distinct benefits for the neonate and the pregnant woman. Buprenorphine is effective in decreasing the risk of relapse in pregnant women. In addition, prenatal use of buprenorphine appears to decrease the severity and duration of neonatal abstinence syndrome as compared with methadone maintenance. Management of buprenorphine includes initiation and maintenance treatment as well as careful planning for pain control during and after delivery and prevention of postpartum relapse risk. Only very small amounts of buprenorphine enter breast milk, making it a good option for those who elect to breast-feed. There is evidence that emerging collaborative care models are effective ways to deliver buprenorphine maintenance treatment, although more investigation is needed to generalize this to the obstetric setting.
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Corresponding Author: Leena Mittal, MD, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston MA 02115 (email@example.com).
Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Submitted for publication: February 11, 2014; accepted for publication: May 20, 2014.