Breastfeeding Rates and the Relationship Between Breastfeeding and Neonatal Abstinence Syndrome in Women Maintained on Buprenorphine During Pregnancy

Introduction: Although a growing body of evidence suggests that buprenorphine is a safe alternative to methadone in the treatment of opioiddependent pregnant women, little is known about breastfeeding in this population. The first objective of this study was to describe breastfeeding rates among opioid-dependent pregnant womenmaintained on buprenorphine in an integrated medical and behavioral health program. The second objective was to determine whether breastfeeding is related to the duration, severity, and frequency of pharmacologic treatment for neonatal abstinence syndrome (NAS). Methods: Aretrospective chart reviewwas conducted for all infants born to opioid-dependent pregnantwomen treated in the integrated buprenorphine program between December 2007 and August 2012. Results: Eighty-five maternal-infant pairs were identified. Sixty-five women (76%) chose to breastfeed their infants after birth; of the women who initiated breastfeeding in the hospital, 66% were still breastfeeding 6 to 8 weeks postpartum. Although the data suggest that infants who were breastfed had less severeNAS (mean peakNAS, 8.83 vs 9.65 on amodified Finnegan Scoring System) and were less likely to require pharmacologic treatment (23.1% vs 30.0%) than infants who were not breastfed, these results were not statistically significant. Discussion: More than three-quarters of the opioid-dependent pregnant women in this case series chose to breastfeed after birth. Although a direct comparison of care models is not possible, the integrated model of care potentially reduced some of the barriers to breastfeeding as the women accessed all their care in a single, infant-friendly setting. Further work is needed to definitively determine whether breastfeedingmitigates NAS.