Congenital Malformations and Choice of Treatment for Opioid Use Disorder in Pregnancy

Untreated opioid use disorder (OUD) during pregnancy is associated with substantial perinatal morbidity and mortality. Opioid agonist medication (buprenorphine or methadone) is recommended management for pregnant patients with OUD although limited pregnancy safety data exist for either medication. Using a U.S. Medicaid database covering the years from 2000 to 2018, researchers identified almost 14,000 live births in which the mother received either a methadone (29%) or a buprenorphine (71%) prescription during the first trimester.

The rate of major congenital malformations was 51 per 1000 pregnancies with buprenorphine and 61 per 1000 pregnancies with methadone. In comparisons that were adjusted for baseline differences between the two group…