EXAMINING DIFFERENCES IN MOTHER-CHILD RELATIONAL OUTCOMES FOLLOWING METHADONE AND BUPRENORPHINE USE DURING PREGNANCY

Abstract

Introduction: The effect of medications for opioid use disorder (MOUD) taken during pregnancy on maternal outcomes in the postpartum period has yet to be examined in human populations. Preclinical literature suggests that taking BUP during pregnancy may increase aggressive maternal behaviors and caregiving deficits. We sought to examine the differences in maternal bonding, connectedness, functioning, and confidence between mothers prescribed buprenorphine (BUP) and those prescribed methadone during pregnancy in the early postpartum period. Methods: Participants were drawn from an observational study of individuals with OUD who were stratified into BUP (n = 9) and methadone (n = 22) groups. At postpartum weeks 4, 8, and 12, participants completed the Postpartum Bonding Questionnaire, Barkin Index of Maternal Functioning, and Karitane Parenting Confidence Scale. For the duration of the study, participants also completed daily surveys in which they reported their feelings of connectedness toward their infants. Independent sample t-tests and regression analyses were used to examine differences between the two groups. Results: Participants in the BUP group, on average, were older, obtained higher levels of education, and were more likely to be partnered than those in the methadone group. No statistically significant differences were found between the BUP and methadone groups in bonding, functioning, confidence, or connectedness outcomes, though some patterns emerged. As revealed in independent sample t-tests, mothers taking methadone had increased impaired bonding and feelings of rejection and anger toward their infants, while mothers taking BUP experienced increased infant-focused anxiety. This pattern was consistent in both adjusted and unadjusted regression analyses. However, in regression analyses, MOUD type was not significantly associated with any postpartum outcomes, including bonding, functioning, parenting confidence, or connectedness, after controlling for covariates. BUP had a moderately large effect on maternal daily connectedness with their infants, particularly at week 4 and week 8, with the effect size decreasing by week 12. Implications: Findings indicating reduced maternal anger and rejection and stronger bonding in the BUP group may hold clinical significance, as early postpartum bonding is a predictor of infant development and maternal mental health. Identifying mothers at risk for bonding impairments enables targeted clinical interventions, such as parenting support and mental health services, to mitigate potential developmental and health risks. Conclusions: The observed pattern that mothers who received BUP during pregnancy may have better early bonding outcomes was inconsistent with findings from preclinical rodent models. Further research is needed in human samples to confirm the findings of this study. Acknowledgements: This research was supported by a grant from the National Institutes of Health (DP2HD105541; PI: Allen). Thank you to Arushi Chalke for your guidance throughout this process, and to Dr. Linde-Krieger for your continued mentorship and encouragement.