Buprenorphine-naloxone (along with methadone) are both evidence-based recommended treatments for patients who are pregnant and struggle with dependence and addiction to opioids.
We encourage all patients to stay on medication for addiction treatment (MAT) during pregnancy—and you can take buprenorphine/naloxone (Suboxone) OR buprenorphine-monotherapy (Subutex) while pregnant.
It was initially thought in the early use of buprenorphine/naloxone (Suboxone) that the naloxone component could cross the placenta and have negative consequences for the pregnancy. While the mono-product (Subutex) was previously the standard of care, this was only because all testing in pregnant patients occurred using this mono-product. However, over time and with further studies, the buprenorphine/naloxone (Suboxone) product has demonstrated that it is just as safe for mom as it is for the baby. Read more about buprenorphine use during pregnancy here.
Suboxone is generally safe to take while pregnant. There are no long term birth defects associated with Medications for Addiction Treatment (MAT). .
Untreated opioid use disorder in pregnant women is associated with fetal development issues, including these:
Therefore, the medical community generally thinks that the risks to untreated opioid use disorder during pregnancy are much greater than the potential risks of either methadone or suboxone.
As far as we currently know, buprenorphine does not have any long term developmental effects on newborns development in utero , However, many babies do experience a period of neonatal abstinence syndrome (NAS) after they are born.
With NAS, a newborn experiences opioid withdrawal symptoms after birth. This can make babies more colicky, irritable, and have more feeding difficulties in the first few days to weeks of life. The good news is Suboxone tends to cause milder NAS than full opioids such as methadone, prescription pills, or heroin/fentanyl.
Therefore, NAS is usually milder in patients on Suboxone during pregnancy than in babies born to mothers who have been using other opioids.
Neonatal abstinence syndrome is a constellation of non-threatening albeit uncomfortable symptoms experienced by babies born to mothers who are on opioids, including suboxone. . Symptoms of neonatal abstinence syndrome include the following:
Most babies will show some signs of NAS after birth. They will typically spend about five days in the hospital after birth for observation. About 50% of children with NAS will need medication to help with these symptoms.
It is difficult to predict which infants will develop NAS and to what extent. Some babies of mothers on high doses of Suboxone can have little to no symptoms, while some babies born to mothers on low doses may have more severe symptoms.
There are many strategies for treating NAS. Depending on the severity of symptoms, babies may simply be treated supportively (without medications) or may require small doses of methadone to ease withdrawal symptoms. Treatment options include the following:
Yes, you should (and can safely) continue taking Suboxone as directed after you give birth.
After you and your baby are discharged from the hospital, it is important for you to keep up with every scheduled doctor’s visit for both you and your newborn. You may also receive some home health care or visits from social workers to assist you and ensure both of you are physically stable.
Yes, it is safe to continue Suboxone during breastfeeding. You do not need to switch to formula just because you are on Suboxone. In fact, breastfeeding a child who was exposed to Suboxone during pregnancy may help to lessen NAS, as the baby receives a tiny bit of Suboxone through its mother’s milk, which helps to wean the baby more slowly off Suboxone and ease any symptoms of NAS.
If you plan to stop breastfeeding, you should do so slowly, on a taper, as your child may have dependence on the buprenorphine in your breast milk. Suddenly stopping can lead to withdrawal symptoms for your baby. Talk to your doctor beforehand.
Not necessarily. Most women who are on Suboxone prior to pregnancy can keep the same dose throughout the pregnancy. Your Suboxone dose may need to be increased or decreased during pregnancy, especially in the third trimester, due to these factors:
If you do feel you need your dose increased or decreased as you progress through your pregnancy, talk to your doctor, who can help to adjust and monitor your dose.
Of course! Pregnant women on Suboxone or another maintenance medication may require additional analgesia during labor. Women on Suboxone may receive epidurals just like any other patient during labor if they chose.
Overall, Suboxone is a safe and effective treatment for OUD and can be continued or even initiated during pregnancy. If you are pregnant and either on Suboxone currently or want to initiate Suboxone, talk to your doctor!