Treating OUD during pregnancy

Pregnancy can be a challenging time for anyone. When you add opioid use disorder (OUD) to the mix, there tends to be a lot of confusion and questions. Untreated OUD is linked to an increased risk of a range of negative pregnancy outcomes, including stillbirth, preterm birth, sudden infant death syndrome (SIDS), neonatal opioid withdrawal syndrome (NOWS), and maternal death. Unfortunately, the number of pregnant women with OUD during labor and delivery has risen significantly in recent years—quadrupling between 1999 and 2015, according to a report from the Centers for Disease Control and Prevention (CDC).

And the majority of pregnant women with OUD do not receive evidence-based treatment, which is treatment using medication. Women deserve better OUD treatment options during pregnancy, and that starts with understanding the science. 

OUD treatment options during pregnancy

Medication-assisted treatment (MAT) is considered the gold-standard treatment for OUD. During MAT, the patient’s doctor or medical provider typically prescribes either methadone or buprenorphine—prescription opioid medications the Food and Drug Administration (FDA) has approved to treat OUD. Pregnant women can safely be on MAT. In fact, this approach is recommended for treating OUD in pregnancy to improve outcomes for both the mother and the newborn.

Methadone + pregnancy

Methadone treatment for OUD is both safe and effective for pregnant women. With the right dose, methadone can help reduce cravings and curb withdrawal symptoms. Infants born to women with OUD who received methadone treatment during their pregnancy have similar outcomes—including healthy birth weight and the likelihood of pregnancy reaching full-term—to infants who were not exposed to methadone in utero. These outcomes are why methadone has traditionally been the go-to treatment option for pregnant women dealing with OUD. 

Buprenorphine + pregnancy

More recent research has shown that treating OUD with buprenorphine in pregnancy may offer some advantages over methadone treatment. One study comparing methadone vs. buprenorphine treatment for pregnant women with OUD found that newborns exposed to buprenorphine in utero had more positive outcomes compared to babies born to pregnant women treated with methadone. They had shorter hospital stays, received a shorter duration of treatment for NOWS, and required 89% less inpatient opioid medication treatment.

Suboxone® vs. Subutex® during pregnancy

Both Suboxone and Subutex are buprenorphine products approved to treat OUD. The key difference between these two medications is that Subutex contains only buprenorphine, and Suboxone contains both buprenorphine and naloxone, a drug that temporarily reverses the effects of an opioid overdose. While Subutex was once preferred for pregnant patients, more current guidelines support the use of Suboxone. 

Can you take Subutex while pregnant? Yes. Like methadone, Subutex is a safe treatment for women dealing with OUD during pregnancy. Some patients experience minor side effects from using Subutex, including constipation, dizziness, and sedation, but these side effects shouldn’t threaten the pregnancy. Women who are pregnant or attempting to conceive when entering treatment for OUD may now choose to begin Subutex or Suboxone. If they’re already on MAT when they become pregnant, they can safely continue their current medication. 

Recent research has shown that exposure to naloxone in utero is not dangerous for developing babies. A study published in 2018 by researchers at West Virginia University found that babies exposed to naloxone in utero fared just as well, if not better, than babies exposed to methadone or buprenorphine alone. Similarly, an analysis of seven studies examining OUD treatments for pregnant women found no significant differences in neonatal and maternal outcomes for buprenorphine-naloxone treatment compared with buprenorphine treatment alone. Pregnant women with OUD are increasingly opting for the combination product, Suboxone, during their pregnancies.

Post-pregnancy OUD treatment 

OUD remains a concern for women even after giving birth to their children. The “fourth trimester” postpartum period is a challenging time for both mother and child because it can be physically and emotionally demanding, which could trigger relapse. Additionally, new mothers need to adjust to their changing health needs and adapt to caring for a newborn with their own health needs. Even with strong evidence in favor of MAT, most pregnant women with OUD do not receive any treatment. Even among those who do, many stop treatment in the months after giving birth due to systemic barriers, like gaps in insurance coverage. 

The risk of overdose increases after delivery, according to one study of women with OUD, and is highest 7 to 12 months post-delivery. Keeping up with MAT after giving birth can help decrease the risk of overdose and other concerns related to untreated OUD. 

Some new mothers may worry about breastfeeding while receiving MAT, but it is safe to breastfeed while taking methadone or buprenorphine. Only a small amount of these medications  pass to the baby  through breastmilk—not enough to be a concern.

In fact, breastfeeding (as well as skin-to-skin contact) are among the first-line recommended interventions for infants who develop Neonatal Opioid Withdrawal Syndrome (NOWS) in utero and encounter degrees of withdrawal after birth, including high-pitched crying, irritability, difficulty feeding, and respiratory problems. New mothers and their care teams may need to work with their healthcare providers/clinicians to adjust the mothers’ medicine dose to accommodate the changes in their bodies postpartum. It’s also important for mothers with OUD to develop a plan for dealing with pain during and after birth. Their methadone or buprenorphine doses will not treat this pain. 

The individualized treatment women deserve during pregnancy and beyond

Ophelia is committed to removing the barriers that keep pregnant women and new mothers from accessing medications for opioid use disorder. Through our personalized telehealth MAT services, patients with substance use disorders can access the treatment they need from the comfort of their homes.