Is buprenorphine use in pregnancy linked to decreased fetal breathing movement

Objective

Biophysical profile (BPP) testing of opioid-exposed fetuses in the third trimester is a commonly used assessment. Opioid use in pregnancy is associated with modest increased odds of stillbirth (OR 1.3). Our hypothesis was that BPP score results in buprenorphine patients might be different from a control group of high-risk patients.

Materials and methods

This retrospective chart review analyzed the BPP assessments of patients receiving buprenorphine compared to patients followed for chronic hypertension. Patients seen between July 1, 2016, to June 30, 2020, were evaluated. Two hundred twenty-seven patients were in the buprenorphine group and 46 patients were in the chronic hypertension control group. The diagnosis of chronic hypertension did not include pre-eclampsia, gestational hypertension, or superimposed pre-eclampsia. Some patients were treated with antihypertensive medications.

Results

Fetuses exposed to maternal buprenorphine administration are more likely to receive a zero score for breathing movements than fetuses receiving BPP assessments due to maternal chronic hypertension. (p-value = 0.002)

Conclusion

This is the first study to show that fetal breathing movement assessment is affected by buprenorphine administration. Current guidelines minimize the effects of maternal buprenorphine administration on fetal development. Further study on the dose-related long-term and short-term effects of buprenorphine on fetal breathing movement is warranted.