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PostPosted: Tue Dec 14, 2010 3:02 pm 
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So the MOTHER study was just published last week, and I got some info on it that I thought I'd pass along. This was a study comparing methadone treatment and buprenorphine treatment in pregnant women and newborns. Most of what I learned had to do with keeping mothers in treatment during pregnancy, and keeping them off other drugs during pregnancy. There was a large section on NAS- comparing babies born on methadone to babies born on bupe. Basically it showed that women inducted onto methadone are more likely to continue treatment (less precipitated withdrawal), but women on Subutex are less likely to use other substances (like cocaine or alcohol).
For both subutex and methadone, there is still no clear link between dose and severity of NAS. Some studies show there is, some studies show there isn't. It's split about 50/50. Factors that can also effect the severity of NAS include are taking multiple drugs (including alcohol and tobacco), poor nutrition, inadequate hydration.

From the NIH website: "This study found that, compared to methadone, buprenorphine resulted in similar maternal and fetal outcomes, yet had lower severity of NAS symptoms, thus requiring less medication (1.1 versus 10.4 milligrams) and less time in the hospital for their babies (10 versus 17.5 days)."

Bupe babies needed 89% less morphine to treat NAS than methadone babies, spent 43% less time in the hospital, and spent 58% less time in the hospital on medication.


That's good news. I do wish there was evidence that a lower dose makes NAS less likely, but maybe next time.

There are more studies coming, including on subutex crossing the placental membrane, and the relationship between dosing time and delivery (that might focus more on Methadone though).

Also interesting tidbit that in methadone patients it benefited mother and baby to split the dose in half and take it twice a day. I figure it couldn't hurt for subutex either!

Finally..... BREASTFEEDING IS SAFE!!!

The amount of sub that passes from mother to child is about 1% of the dose. Of that 1%, about 1/10th of it makes it into the babies system. That means if you take 2mg then .02mg (20 mcg) are in breastmilk, and .002mg (2mcg) enter the baby's bloodstream. Seriously, that is less than a trace. Babies who show signs of NAS DO benefit from breastfeeding, but the researchers believe this has less to do with the milk and more to do with things like swaddling, skin-to-skin contact, and other soothing factors.

I didn't see any info about suboxone and pregnancy, or suboxone and breastfeeding.

I took a bunch of notes. Let me know if you have any ?'s


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 Post subject: OMG!!!!!!!
PostPosted: Tue Dec 14, 2010 3:35 pm 
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Wow, thank you so very, very much for sharing that with all of us. It's so interesting that the dosage doesn't always correlate with whether babies have NAS. As you know, I took 3 mg Subutex my whole pregnancy, up until the last week (when I was told to discontinue to because of my impending surgery), and my baby had zero w/d, stayed in the room w/ me, came home w/ me, etc.. I don't know why I got lucky. The one thing that I remember clearly that maybe made a difference is that I did drink tons and tons of water. I drank at least 1 gallon per day, because the fetal specialist kept on hammering it into me that it was very important to do so. I actually kept a tally of ounces on a white board. I wonder if that was a big help. Also, I spaced my three mg out in three separate doses, one every 8 hours. I took it that way like clockwork to minimize the amount in my system at any particular time. I do think this probably made a difference. I also did eat very healthy and always, always took my vitamins. I just tried to do all the other things as best I could, after I realized that I was going to need to stay on Sub.

As far as the breastfeeding, I'm actually crying right now. Wow, big emotions about this. I'm so happy to hear that, but I'm so sad that I didn't breastfeed. Boy, I wanted to soooo badly, but one out of three doctors said it was too dangerous, and that scared me enough that I didn't do it. To me, that was a humongous loss, too big a loss to even put a price on. I hope other moms will read this and realize they don't need to give up breastfeeding. I wish I'd known back then. Bupemom, you will get to breastfeed your little angel baby. Aren't you excited??? I'm excited for you!!

Thank you so much!!!!!

laddertipper

_________________
First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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PostPosted: Tue Dec 14, 2010 9:34 pm 
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You did great!! I bet the hell week of w/d (which I can't believe any doctor would recommend for a pregnant woman) helped your baby, and all that water you drank! I am not as healthy eating as I should be- I was in the beginning, but as soon as I entered the 3rd trimester (and full-time classes) I stopped eating so well. Carbs Carbs Carbs!!! Also I never drink water- I drink a lot of tea, but not like a gal. of water/ day!! I should, I'd probably be less swollen!!! After I heard the results, I started taking extra folic acid again. Can't hurt, can it?

The women in this study took between 2mg-24mg. I don't know why they didn't have any conclusion on a correlation of dose to NAS. She (Dr. Hendree Jones) cited previous studies on dosing and NAS severity, but didn't share any of her own results. Maybe they are in the long version of the study, but she kind of ignored the issue in her presentation.

The breastfeeding conclusions were backed up by a previous study from I think 2008. I am SO happy about this!! My doctors have been encouraging me to breastfeed, but there are always doubts when you're on any type of medication. Obviously women who shouldn't nurse include any woman who tested positive for Hep C or HIV, and any woman using other substances, including alcohol.

I am so sorry this info wasn't published before your baby was born. I think I will be crushed if I am unable to nurse. I am glad you took every precaution, and made the choices you did, though. Given all the info you had, you really made great choices and you should be very proud!!


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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