Can I Take Suboxone While Pregnant?

Yes! 

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.

Are There Risks to Suboxone Treatment During Pregnancy?

‍Suboxone is generally safe to take while pregnant. There are no long term birth defects associated with Medications for Addiction Treatment (MAT). [2]. 

Untreated opioid use disorder in pregnant women is associated with fetal development issues, including these:[1]

• Low birth weight
• Preterm birth
• Fetal death

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.

Are There Any Side Effect in Babies Whose Mothers Are on Suboxone After Birth?

As far as we currently know, buprenorphine does not have any long term developmental effects on newborns development in utero [2], 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.

What is Neonatal Abstinence Syndrome (NAS)? 

Neonatal abstinence syndrome is a constellation of non-threatening albeit uncomfortable symptoms experienced by babies born to mothers who are on opioids, including suboxone. [4]. Symptoms of neonatal abstinence syndrome include the following:

• Irritability
• Hyperactivity
• Abnormal sleep patterns
• High-pitched crying
• Tremors
• Vomiting
• Diarrhea
• Failure to gain weight 

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. 

How Is NAS Treated?

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:

• Place the infant in a dark, quiet area to reduce stimulation from light and sound.
• Swaddle the infant.
• Gently rock or use other positioning held against the body to relax the baby.
• Provide frequent, small amounts of breast milk or formula to ease feeding problems and ensure the baby receives enough calories.
• Allow the infant to stay in the same hospital as their mother.
• Work with volunteers to have consistent physical human contact to soothe the baby.
• Administer liquid oral morphine or methadone in the case of extreme withdrawal symptoms.
  

Should You Continue Suboxone Treatment After the Baby Is Born?

‍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.

Can you breastfeed on Suboxone?

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.

Will My Suboxone Dose Change During Pregnancy?

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:

• Increased fluid in the body
• Faster metabolism
• Being metabolized by the placenta and fetus
• More excretion through the kidneys

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. 

Can I Receive Additional Pain Control During Labor If I am on Suboxone?

Of course! ‍Pregnant women on Suboxone or another maintenance medication may require additional analgesia during labor[3]. 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!

SOURCES

1. Highlights of Prescribing Information: Suboxone. Suboxone.com. https://www.suboxone.com/pdfs/prescribing-information.pdf. March 2021. Accessed February 2022.
2. Clinical Guidelines for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants. Substance Abuse and Mental Health Services Administration (SAMHSA). https://store.samhsa.gov/sites/default/files/d7/priv/sma18-5054.pdf. Accessed February 2022.
3. Buprenorphine & Naloxone (Suboxone). The Royal Women’s Hospital. https://www.thewomens.org.au/images/uploads/fact-sheets/YAYB-Buprenorphine-250818.pdf. August 2018. Accessed February 2022.
4. Neonatal Opioid Withdrawal Syndrome. American Academy of Pediatrics (AAP). https://publications.aap.org/pediatrics/article/146/5/e2020029074/75310/Neonatal-Opioid-Withdrawal-Syndrome. November 2020. Accessed February 2022. 
5. Treatment for Opioid Use Disorder Before, During, and After Pregnancy. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/pregnancy/opioids/treatment.html. July 2021. Accessed February 2022.