Increased Skeletal Anomalies are Found in Ultrasound Evaluation of Buprenorphine-Exposed Human Fetuses
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
80
Name of Project's Faculty Sponsor
Martin Olsen
Faculty Sponsor's Department
Obstetrics and Gynecology
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
Introduction: Buprenorphine (Subutex® and Suboxone®) is the primary source of maternal opioid exposure in the region of the study. Current recommendations exist that perinatologists should perform level II ultrasounds on patients with substance use disorders. For some patients, distance, transportation, and costs associated with obtaining ultrasounds from a specialist pose significant barriers. In light of the increasing prevalence of substance-exposed patients, we conducted this study to determine if such patients’ ultrasounds could be managed by general obstetricians. Our hypothesis posited that, if the incidence of congenital anomalies remained consistent between the substance-exposed and non-exposed pregnancies, then generalist ultrasounds might be sufficient for both groups. Methods: In a retrospective chart review comparing 1,188 substance-exposed patients to 1,261 non-exposed, anomaly data was collected from level I and level II anatomy scans, problem lists on ACOG sheets, and visit notes. If anomalies were detected, they were further classified by the affected organ system. Two proportion tests were used to compare the exposed and unexposed groups. When the assumptions were not met, a Fisher’s exact test and the Benjamini Hochberg method were used to adjust for multiple testing. Results: Buprenorphine exposed fetuses have increased rates of composite skeletal anomalies when compared with non-exposed fetuses (p<0.005). No statistically significant difference, however, was found between groups for any other system or for any specific skeletal anomaly. No statistically difference was found related to buprenorphine dose. Conclusion: The subcutaneous administration of buprenorphine has been linked to significant increases in skeletal anomalies in rats and rabbits. However, this association has never been recorded in humans. Therefore, further research is indicated. Conclusively, our findings suggest that generalist OB/GYNs may effectively conduct ultrasound analysis for substance-exposed patients, provided these patients are willing to accept the potential risk of skeletal anomalies in pregnancy.
Increased Skeletal Anomalies are Found in Ultrasound Evaluation of Buprenorphine-Exposed Human Fetuses
D.P. Culp Center Ballroom
Introduction: Buprenorphine (Subutex® and Suboxone®) is the primary source of maternal opioid exposure in the region of the study. Current recommendations exist that perinatologists should perform level II ultrasounds on patients with substance use disorders. For some patients, distance, transportation, and costs associated with obtaining ultrasounds from a specialist pose significant barriers. In light of the increasing prevalence of substance-exposed patients, we conducted this study to determine if such patients’ ultrasounds could be managed by general obstetricians. Our hypothesis posited that, if the incidence of congenital anomalies remained consistent between the substance-exposed and non-exposed pregnancies, then generalist ultrasounds might be sufficient for both groups. Methods: In a retrospective chart review comparing 1,188 substance-exposed patients to 1,261 non-exposed, anomaly data was collected from level I and level II anatomy scans, problem lists on ACOG sheets, and visit notes. If anomalies were detected, they were further classified by the affected organ system. Two proportion tests were used to compare the exposed and unexposed groups. When the assumptions were not met, a Fisher’s exact test and the Benjamini Hochberg method were used to adjust for multiple testing. Results: Buprenorphine exposed fetuses have increased rates of composite skeletal anomalies when compared with non-exposed fetuses (p<0.005). No statistically significant difference, however, was found between groups for any other system or for any specific skeletal anomaly. No statistically difference was found related to buprenorphine dose. Conclusion: The subcutaneous administration of buprenorphine has been linked to significant increases in skeletal anomalies in rats and rabbits. However, this association has never been recorded in humans. Therefore, further research is indicated. Conclusively, our findings suggest that generalist OB/GYNs may effectively conduct ultrasound analysis for substance-exposed patients, provided these patients are willing to accept the potential risk of skeletal anomalies in pregnancy.