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Opioid Detoxification During Pregnancy: A Systematic Review

Terplan, Mishka, MD, MPH; Laird, Hollis, J., MPH; Hand, Dennis, J., PhD; Wright, Tricia, E., MD, MS; Premkumar, Ashish, MD; Martin, Caitlin, E., MD, MPH; Meyer, Marjorie, C., MD; Jones, Hendrée, E., PhD; Krans, Elizabeth, E., MD, MSc

doi: 10.1097/AOG.0000000000002562
Contents: Drugs in Pregnancy: Review

OBJECTIVE: To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy.

DATA SOURCES: PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016.

METHODS OF STUDY SELECTION: English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale.

TABULATION, INTEGRATION, AND RESULTS: Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]).

CONCLUSIONS: Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

Evidence supports recommendations that promote opioid pharmacotherapy over detoxification during pregnancy owing to low completion rates of the latter, high relapse rates, and limited outcome data beyond delivery.

Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, Richmond, Virginia; the Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Obstetrics & Gynecology, Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, Hawaii; the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Department Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics, Gynecology & Reproductive Services, University of Vermont, Burlington, Vermont.

Corresponding author: Mishka Terplan, MD, MPH, Department of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, 1200 E Broad Street, Box 980268, Richmond, VA 23298; email: mishka.terplan@vcuhealth.org.

Research reported in this publication was supported in part by the National Institute on Drug Abuse (NIDA) under Award Number K23DA038789 (Dr. Krans). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Carrie Everstine, MLS, for her assistance with the database searches and systematic review process.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.