Nurse Practitioner Managed Outpatient Induction Onto Buprenorphine/Naloxonein Women With Opioid Use Disorder During Pregnancy: A Retrospective Cohort Analysis

A Cohort Analysis. Abstract Objective: To compare maternal, fetal and neonatal clinical char- acteristics and outcomes of Nurse Practitioner managed outpatient induction and community induced transfers of buprenorphine/nalox-one treatment during pregnancy. Methods: A retrospective cohort analysis of patients managed by nurse practitioner and treated with buprenorphine/naloxone for opioid use disorder during pregnancy and their neonates. N=319 moth- er-neonate dyads were treated at the University of North Carolina Horizons’ Clinic between January 1, 2014 and May 31, 2018. N=51 mother-neonate dyads that underwent buprenorphine/naloxone induction via the Horizons’ Clinic protocol versus n=44 mother-ne- onate dyads that underwent community buprenorphine/naloxone induction via an outside provider and transferred to Horizons’ for pre- natal care and management of Medications for Addiction Treatment (MAT) during pregnancy were compared. Demographic data; maternal, fetal, and neonatal clinical characteristics; and clinical outcomes were collected via chart review. Results: No significant differences were found in maternal clinical characteristics between the two groups. Estimated Fetal Weight (EFW) percentile was the only significantly different fetal outcome with the Horizons’ induction group having a significantly higher mean EFW percentile compared to those who underwent community induction (41.8vs. 35.7, P=0.042). Finally, no significant differences in preterm birth or low birth weight were found between Horizons’ induction group and the North Carolina state averages. Conclusion: The induction protocol utilized by the UNC Horizons prenatal clinic shows similar safety and efficacy in pregnancy out comes compared to community induced transfers. The outcomes for both groups indicate relative safety and effectiveness of buprenor-phine/naloxone during pregnancy. Nurse practitioner prescribing and outpatient protocols could help expand access to MAT by providing more options for patients. outcome variables were meant to demonstrate safety and effectiveness for mother, fetus and neonate before, during and after pregnancy. Findings suggest that rates of normal anatomy ultrasound screenings, percentage of FHR within normal limits, gestational age at birth, birth weight in grams, 1 and 5 minute APGAR scores, new born days in nursery, and rates of NAS requiring medication inter vention during pregnancy do not differ significantly between patients who underwent the Horizons’ induction and those who underwent community induction. Remarkably, the only significant difference in outcomes was positive: patients in the Horizons’ induction group had significantly higher EFW percentile compared to those who under went community induction (41.8 vs. 35.7, P=0.042). EFW is a mea sure of normal fetal growth and can be a predictor for LBW. is an exciting finding due to the high incidence of low birth weight among patients This study shows that buprenorphine/naloxone has relative safety and effectiveness during pregnancy regardless of induction in the clinic or in the community. With the exception of EFW percentile, these data do not evidence are