Opioid Detoxification During Pregnancy: A Systematic Review : Obstetrics & Gynecology

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Contents: Drugs in Pregnancy: Review

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

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Obstetrics & Gynecology 131(5):p 803-814, May 2018. | DOI: 10.1097/AOG.0000000000002562


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


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


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.


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%]).


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.

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

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