Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, Richmond, Virginia; the Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Obstetrics & Gynecology, Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, Hawaii; the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Department Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics, Gynecology & Reproductive Services, University of Vermont, Burlington, Vermont.
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OBJECTIVE:To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy.DATA SOURCES:PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016.METHODS OF STUDY SELECTION:English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale.TABULATION, INTEGRATION, AND RESULTS:Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]).CONCLUSIONS:Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.