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Am J Perinatol 2020; 37(07): 679-688
DOI: 10.1055/s-0039-1688908
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review

Craig V. Towers
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
,
Paul Terry
2   Department of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
,
Breanne Rackley
3   College of Arts and Sciences, University of Tennessee, Knoxville, Tennessee
,
Mark Hennessy
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
,
Kevin Visconti
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
› Author Affiliations Funding None.
Further Information

Publication History

06 April 2019

08 April 2019

Publication Date:
19 May 2019 (online)

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Abstract

Objective This study aimed to perform a systematic review of all studies reporting fetal outcomes following detoxification or tapering of opioid drugs during pregnancy.

Study Design PubMed, Scopus, Medline, and Google Scholar were searched, and only manuscripts clearly reporting pregnancy/fetal outcomes involving tapering or detoxification from opioid drugs were included. Only pregnancies managed after 1980 were included (when antenatal fetal surveillance became more routine). Collected data included study design, location, years patients were managed, number of patients who were tapered or detoxified, method of tapering, and pregnancy outcome.

Results A total of 14 publications met the criteria for review after evaluating more than 2,000 abstracts and 153 published manuscripts. In 1,097 pregnancies, based on mortality rate analyses and forest plots, no increased fetal risks due to tapering or detoxification from opioid drugs were identified. No increased risk of preterm delivery was found.

Conclusion Pregnant women with opioid use disorder who are stable in a medication-assisted treatment program with behavioral health can be informed that tapering or full detoxification from opioid drugs does not increase the fetal risk of poor pregnancy outcome. Future research needs to answer the questions on maternal and long-term newborn consequences of tapering or detoxification versus long-term newborn consequences of continued chronic in utero opioid exposure.

Keywords

opioid use disorder - substance abuse - drug abuse - neonatal abstinence syndrome - overdose - methadone - buprenorphine - naltrexone - heroin
 

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