Mantri 2024: babies exposed to naltrexone vs buprenorphine-naloxone in pregnancy

What they tested

Pregnant people taking prescribed naltrexone or buprenorphine-naloxone (the drugs in Suboxone) were enrolled during pregnancy at several centers, and each parent and baby were followed until 12 months after birth.

Babies were assessed at 4–6 weeks, with age corrected for early birth, using the NICU Neonatal Neurobehavioral Scale (NNNS). At 12 months they were assessed with the Ages and Stages Questionnaire, Third Edition (ASQ-3), a development checklist.

What they found

At 4–6 weeks, babies exposed to naltrexone had higher median scores for arousal and excitability, and lower median scores for attention and regulation, than babies exposed to buprenorphine-naloxone.

None of the naltrexone-exposed babies were monitored for neonatal opioid withdrawal syndrome (NOWS), and they had shorter hospital stays.

At 12 months, there were no statistically significant differences. More babies in the buprenorphine-naloxone group were flagged as at risk of delays in communication, problem solving and personal-social skills.

Limits

• Only 7 babies were in the naltrexone group, and the authors say the results should be interpreted with caution.
• It was observational, so differences between the groups may reflect who was taking each medicine rather than the medicine itself.

What it means if you're considering naltrexone

Data on naltrexone in pregnancy are scarce, and the authors say long-term outcomes for exposed babies had not been studied before. This study found no withdrawal monitoring and shorter hospital stays with naltrexone, and similar development scores at 12 months, but it is too small to settle the question.