Opioid misuse during pregnancy is dangerous to both mom and her baby. Unfortunately, it’s also common, and undertreated.
The number of women diagnosed with opioid use disorder (OUD) during pregnancy increased from 49.6 per 1,000 in 2014 to 54.1 per 1,000 in 2017.
This article covers the risks associated with opioid use, misuse, and OUD during pregnancy. We also discuss why Medication for Addiction Treatment (MAT) is the best approach and which medications are commonly prescribed during pregnancy.
Risks Associated With Opioid Use During Pregnancy
There are numerous risks of opioid misuse during pregnancy. Some directly impact you and your health, and others can affect your unborn child.
Common problems associated with opioid misuse during pregnancy include the following:
- Birth defects
- Fetal convulsions
- Fetal death
- Infection (HIV, hepatitis) and malnutrition secondary to high-risk behaviors and poor prenatal care
- Maternal death
- Neonatal abstinence syndrome
- Preterm labor
- Stunted growth
Your untreated OUD can also lead to varying levels of opioids inside your body. That fluctuation can lead to repeated cycles of withdrawal for your baby. That trauma can impair placenta function, which is your connection to your baby. This can lead to some of the symptoms listed above. It can also lead to neonatal abstinence syndrome (NAS).
What Is Neonatal Abstinence Syndrome?
Substances a woman ingests during her pregnancy can pass to her baby through the umbilical cord. Opioids like oxycodone and morphine can travel through the umbilical cord and get into your baby’s body and brain. This can lead them to become dependent on opioids while in the womb, and when they are born, they can go through withdrawal just like an adult. This is call Neonatal abstinence syndrome (NAS). NAS refers to a cluster of symptoms of withdrawal seen in babies born to women with OUD.
Every day, about 80 newborns are diagnosed with NAS in American hospitals. Signs of NAS occur within 72 hours after birth and include the following symptoms:
- Difficulty sucking and feeding
- High pitched crying
- Hyperactive reflexes
- Increased sweating
- Stuffy nose
- Tremors or trembling
- Trouble sleeping
Some babies have very minimal symptoms and do not require any medications for NAS. Others may require temporary medications. Doctors sometimes use medications like morphine or methadone to help babies recover from NAS. As babies get bigger, their doses get smaller. Soon, they’re taking no medications at all and are safely weaned off these medications.
Opioid Use Disorder Treatments During Pregnancy
All women with OUD should consider treatment with MAT throughout their pregnancy to block cravings and prevent relapse. As the American College of Obstetricians and Gynecologists points out, withdrawal isn’t always safe for women during pregnancy, but medication management is comparatively very safe. 
Three primary types of medications are used in MAT.
Like morphine, fentanyl, and heroin, methadone is a full opioid agonist that activates the opioid receptors in the brain and serves as a substitution for other opioids, preventing withdrawal. For over half a century, methadone has been used to treat OUD.
Methadone is currently only dispensed at specially licensed methadone clinics. While the can present a burden for some women, some women may actually prefer the accountability of going to a program on a regular basis during their pregnancy to help keep them on track to recovery.
Buprenorphine is a partial agonist at the opioid receptor. Like methadone, it can block cravings and withdrawal symptoms and prevent relapse.
However, buprenorphine has an additional safety advantage over methadone. At higher doses, it has a ceiling effect, meaning the opioid agonist effect doesn’t increase past a certain dose. As a result, it is much harder to overdose on buprenorphine than methadone and other full agonists.
Although NAS can occur upon delivery in patients on buprenorphine, NAS symptoms are generally less severe than patients on methadone. 
Until recently, Subutex – a formulation of Buprenorphine without Naloxone – was used in pregnant women almost exclusively because of concerns that naloxone might cross the placenta and cause adverse effects. However, more recent studies show that very little placental transfer occurs and that Suboxone is just as safe for fetuses as Subutex. Brand name Subutex is no longer available in the U.S. These days, prescribers usually recommend Suboxone for pregnant women.
Naltrexone, often given in a monthly injectable form, is the third medication sometimes used to prevent relapse in OUD because it blocks craving and prevents relapse. Unlike buprenorphine and methadone, naltrexone (Vivitrol) is an opioid receptor blocker, not an agonist.
Until recently, naltrexone was not a recommended treatment for pregnant women with OUD, except for those already taking naltrexone for OUD before they got pregnant.
Although still not standard of care, it is increasingly being used off-label for OUD treatment in pregnancy, and more research into its safety and efficacy is underway. So far, rates of adverse effects from naltrexone or Vivitrol compared to methadone or buprenorphine and untreated OUD appear to be similar.
Why Should You Treat OUD During Pregnancy?
Study after study shows that MAT is better for the mother and the fetus than no MAT, such as the use of 12-step programs or counseling alone. Relapse rates without MAT are high, and repeated cycles of withdrawal and intoxication associated with untreated OUD are dangerous.
If you have questions about MAT while pregnant, schedule a time to speak with one of our professionals, or call us today at (844) 943-2514.
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
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- Treating Opioid Use Disorder During Pregnancy. National Institute on Drug Abuse. https://nida.nih.gov/publications/treating-opioid-use-disorder-during-pregnancy. July 2017. Accessed January 2023.
- Data and Statistics About Opioid Use During Pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/pregnancy/opioids/data.html. November 2022. Accessed January 2023.
- Neonatal Abstinence Syndrome: Essentials for the Practitioner. Journal of Pediatric Pharmacology and Therapeutics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187528/. July 2014. Accessed January 2023.
- Opioid Use and Opioid Use Disorder in Pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy. August 2017. Accessed January 2023.
- Prenatal Buprenorphine Versus Methadone Exposure and Neonatal Outcomes: Systematic Review and Meta-Analysis. American Journal of Epidemiology. https://academic.oup.com/aje/article/180/7/673/150018. October 2014. Accessed January 2023.
- Suboxone May Be Safer for Women in Pregnancy. West Virginia Perinatal Partnership. https://wvperinatal.org/suboxone-may-be-safer-for-women-in-pregnancy/. Accessed January 2023.
- MCSTAP Learning Case: Prescribing Vivitrol for a Pregnant Woman. Massachusetts Consultation Service for Treatment of Addiction and Pain. https://www.mcstap.com/docs/Prescribing%20Vivitrol%20for%20a%20Pregnant%20Woman.pdf. Accessed January 2023.
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