This review combines published evidence with an institutional retrospective chart review of buprenorphine dosing during pregnancy and the first postpartum year. Dose increases and divided daily dosing were common as pregnancy progressed, but individual trajectories varied substantially during pregnancy and after delivery. The authors recommend frequent reassessment and shared, individualized dose decisions rather than applying a uniform dosing schedule. The evidence reviewed is observational and does not establish one optimal dose for all patients.
Abstract
Purpose of Review:
Opioid-related deaths are a leading cause of mortality during pregnancy through 12 months postpartum. Buprenorphine use during pregnancy is increasing, yet expert opinion on its dosing through the perinatal period is limited. We provide a review of the current clinical literature on buprenorphine dosing during pregnancy through 12 months postpartum. and present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers.
Recent Findings:
Existing literature during pregnancy reflects how many women increase and split total daily buprenorphine doses as gestational age advances.
Summary:
We present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers. Changes in the total daily dose of buprenorphine used across pregnancy and through 12 months postpartum at the individual level do not follow consistent patterns, highlighting substantial individual variability. Altogether, buprenorphine dosing should be individualized through pregnancy and postpartum with frequent evaluations by providers and solicited input from patients.
