Methadone is used as a treatment for opioid use disorder (OUD) for a large subset of pregnant patients.[1] According to an analysis by the CDC, more than 6% of surveyed women reported taking opioids at some point while pregnant, and 21% of those women said that they misused opioids during their pregnancy. [2]
While methadone use during pregnancy comes with some risks, the benefits outweigh those risks in many cases. Most doctors recommend treating OUD with medications during pregnancy – either with Suboxone or Methadone.
What Is Methadone?
Along with buprenorphine and naltrexone, methadone is one of three FDA-approved medications for opioid use disorder.[3]
Methadone is an opioid agonist that binds to opioid receptors in the brain, filling the area where opioids would normally bind. In patients with OUD, methadone prevents cravings and withdrawal symptoms that would normally occur if these receptors were empty.
Patients who use illicit opioids (heroin or fentanyl) or misuse legal opioids (oxycodone or hydrocodone) might meet the criteria for OUD and could benefit from methadone treatment while pregnant.
Is It Safe to Get Pregnant While on Methadone?
Overall, it is safe to get pregnant while on methadone. The medication can be prescribed during pregnancy to women with OUD.
Methadone is classified as a Class C medication in pregnancy.[4] This means it is safe to use during the entirety of the pregnancy as it is is thought to have a low risk of teratogenicity (does not cause birth defects in the fetus).
However, there are some risks to using methadone during pregnancy, particularly the risk of neonatal abstinence syndrome.[5]
How Does Methadone Affect Pregnancy?
When used during pregnancy, methadone crosses the placenta, and babies get exposure to the opioid effects of methadone while growing in utero. Therefore, they can be born physiologically dependent on methadone, the same way an adult can be dependent on methadone.
The degree of severity of NAS can vary greatly between infants and depends on a number of factors.[7]
- Babies born to mothers on high doses of methadone may experience more severe NAS.
- Babies born early or preterm may have worse NAS symptoms than those born on time.
- Babies born to women taking multiple medications that cause dependency in addition to methadone (benzodiazepines, SSRIs, etc) may have more severe withdrawal symptoms.
It is hard to predict the degree to which a baby will experience NAS. As a result, these babies are carefully monitored after delivery, and moms are given additional support and supervision.
What Is Neonatal Abstinence Syndrome?
Neonatal abstinence syndrome (NAS) is the constellation of symptoms associated with a baby withdrawing from methadone or other opioids after birth.[6] The main complications of methadone use during pregnancy do not occur during the pregnancy itself but after delivery.
Even though NAS may be a difficult condition, it is not life-threatening.
Neonatal Abstinence Syndrome Symptoms
The symptoms of withdrawal experienced by babies are similar to those experienced by adults, such as these:
- Anxiety
- Shakiness
- Extreme colic
- Sweating
- Diarrhea
- Runny nose and congestion
- Poor sleep
NAS tends to start within the first 24 to 48 hours of life, and it usually lasts for the first five to seven days after birth.
In their first week or two of life, NAS babies are notoriously colicky and fussy, and they have difficulty eating enough calories to gain weight. These babies are often kept in the hospital for a week or more during the withdrawal period to ensure they are eating adequately and gaining weight appropriately.
How Does an Infant Get Treated for NAS?
There are several different treatments for NAS after delivery.[7]
A large part of the care is supportive or non-pharmacological. This includes additional support from nurses to help the baby with breastfeeding and latching as well as support from hospital social work teams.
NAS can also be treated with certain medications, including small doses of methadone itself. However, methadone can be used to treat NAS only for a short period while the baby is in recovery in the hospital.
Using Methadone During Pregnancy
Any decision to use treatment during pregnancy has risks and benefits. Untreated OUD during pregnancy can lead to the following:[8]
- Accidental overdose
- Death
- Malnutrition
- Increased risk for physical abuse
- Preterm labor
- Risk of infection from needle use
For some women, the risks of NAS might be significantly lower than the risk of untreated OUD during pregnancy.
If OUD is left untreated, many doctors and women believe that the risks of self-harm or harm to the baby during pregnancy outweigh the risks of NAS. Therefore, they decide to initiate or continue methadone during their pregnancy.
Research suggests that treatment with methadone during pregnancy is safe and better than abstinence-only therapy for multiple outcomes during childbirth.[1]
How Bicycle Health Can Help With OUD Treatment During Pregnancy
If you are pregnant and struggling to overcome an opioid use disorder, reach out to a doctor to discuss the benefits of methadone or Suboxone treatment during pregnancy. Bicycle Health uses Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.
Photo by Amina Filkins from Pexels
Medically Reviewed By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
- Opioid Use and Opioid Use Disorder in Pregnancy. The American College of Obstetrics and Gynecology. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy. May 2012. Accessed March 2023.
- Vital Signs: Prescription Opioid Pain Reliever During Pregnancy — 34 U.S. Jurisdictions, 2019. https://www.cdc.gov/mmwr/volumes/69/wr/mm6928a1.htm. July 2020. Accessed March 2023.
- Methadone and Pregnancy: Opioid Addiction During Pregnancy. Health Care Resource Centers. https://www.hcrcenters.com/blog/methadone-and-pregnancy-opioid-addiction-during-pregnancy/. Accessed March 2023.
- Methadone Pregnancy and Breastfeeding Warnings. Drugs.com. https://www.drugs.com/pregnancy/methadone.html. Accessed March 2023.
- Neonatal Abstinence Syndrome After Methadone or Buprenorphine Exposure. New England Journal of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073631/. June 2011. Accessed March 2023.
- Differences in the Profile of Neonatal Abstinence Syndrome Signs in Methadone- Versus Buprenorphine-Exposed Neonates. Addiction. https://pubmed.ncbi.nlm.nih.gov/23106927/. November 2012. Accessed March 2023.
- Neonatal Abstinence Syndrome. Pediatric Clinics of North America. https://pubmed.ncbi.nlm.nih.gov/30819342/. April 2019. Accessed March 2023.
- Neonatal Abstinence Syndrome: Advances in Diagnosis and Treatment. JAMA. https://pubmed.ncbi.nlm.nih.gov/29614184/. April 2018. Accessed March 2023.
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