Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

  • * death

  • * life-threatening

  • * hospitalisation

  • * disability

  • * congenital anomaly

  • * other medically important event

In a case report study, two neonates [one boy and one girl; exact ages not stated] developed neonatal abstinence syndrome, a withdrawal syndrome following an in utero exposure to buprenorphine.

The mother of the neonates presented for IVF in her mid-30s. She was a known case of substance use disorder (opioid and nicotine). At the age of 17, she entered in an opioid maintenance treatment with methadone (for a total of 3 years) and buprenorphine (for a total of 10 years, with interruptions). Thereafter, she presented to the addiction clinic and was maintained on buprenorphine with a daily dose of 16mg, which she had received close to one year. During the IVF (pregnancy), her buprenorphine dose remained stable at 16mg daily. At 32 weeks of gestation, her urine analysis showed negative results for concomitant substances (opioids, cocaine, amphetamines, benzodiazepines and cannabis). At 38 weeks of gestation, she was scheduled for a caesarean section because of the twin pregnancy. Thereafter, she delivered healthy dichorionic twins (a boy and a girl) with birth weight of 3140g (male neonate) and 2650g (female neonate), and Apgar score for both neonates was 9/10/10. However, both the neonates developed an unusual course of neonatal abstinence syndrome (NAS).

The neonates were treated with morphine (morphine hydrochloride), which was gradually increased and then decreased in both the neonates. The treatment dose was maintained for both the neonates. On postpartum day 40, both neonates were discharged.

Author comment: "This unique case report is the first to describe an opioid maintained woman with an IVF twin pregnancy, focusing on maternal and neonatal outcomes and the treatment of [neonatal abstinence syndrome] following an uncomplicated pregnancy. . .This is the first case report on neonatal outcomes of IVF-conceived twins exposed to buprenorphine in utero, detailing the [neonatal abstinence syndrome] course and treatment."