Wachman 2024: outcomes for 7 people treated with naltrexone in pregnancy

What they tested

Researchers followed 7 pregnant people from pregnancy through 12 months after delivery. Four had opioid use disorder and 3 had alcohol use disorder. Three took naltrexone tablets and 4 had the extended-release monthly shot.

On average, people joined the study at 21.7 weeks of pregnancy. The team described each person's treatment plan and the outcomes for parent and baby during pregnancy, delivery and the year after birth. There was no comparison group.

What they found

No one returned to nonprescribed opioid use during the study. Two returns to alcohol use were recorded.

Everyone delivered vaginally, at a mean of 37 weeks, with no reported problems controlling pain around delivery. There was one preterm delivery and no reported fetal anomalies.

None of the babies developed neonatal opioid withdrawal syndrome, the withdrawal some newborns go through after opioid exposure in the womb. Five of the 7 (71.4%) were still on naltrexone a year after giving birth.

Limits

• With 7 people, the series is far too small to detect uncommon problems for parent or baby.
• There was no comparison group, so it can't show whether outcomes were better or worse than with other treatments or no medicine.
• Everyone was treated in one program that followed its own clinical protocols, so the results reflect that setting.

What it means if you're considering naltrexone

The authors start from the point that little is known about how safe and effective naltrexone is in pregnancy. This series adds early, reassuring detail on parent and baby outcomes, but it can't settle how naltrexone compares with other options, and it doesn't replace a decision made with a care team.