Opioid Use Disorder in Pregnancy: 7 Facts To Know

Facing opioid use disorder (OUD) during pregnancy can be scary and overwhelming, especially with all the misunderstanding around it. It’s important to know that OUD is a medical condition, not a moral failing, and it can be treated. Getting the right information, support, and care can make a big difference for both you and your baby.

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With help like prenatal care, mental health support, and treatment, recovery is possible. In this article, you’ll learn seven key facts about OUD during and after pregnancy, so you can feel more confident and prepared on your journey.

1. OUD During Pregnancy Can Affect Both Mother and Baby

OUD can affect your own health. It can be linked to health problems like depression, poor nutrition, and other medical conditions. When your body is focused on managing cravings and withdrawal, it can also be harder to keep up with healthy habits like good hygiene, exercise, and sleep. OUD also increases your risk of infections during pregnancy.

Use of opioids during pregnancy raises the risk of newborn complications, including:

• Preterm birth
• Low birth weight
• Birth defects
• Miscarriage
• Neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome

NAS occurs when newborns experience withdrawal after prenatal opioid exposure. Symptoms such as poor feeding, crying more than normal, and not sleeping well usually start within three days after birth. NAS symptoms can last up to six months.

For this reason, receiving OUD treatment can improve your baby’s health as well as yours.

2. Stopping Opioids Suddenly Can Be Harmful

Health experts don’t recommend trying to quit opioids suddenly. Going cold turkey can trigger withdrawal symptoms in both you and your unborn baby. Sudden withdrawal can cause strong physical reactions, such as:

• Muscle aches
• Nausea or vomiting
• Anxiety
• Rapid heartbeat
• Sweating

Repeated episodes of opioid withdrawal can also increase the risk of poor fetal growth, preterm labor, and stillbirth.

Doctors recommend using medication-assisted treatment (MAT) during pregnancy instead of abruptly stopping. MAT lowers the risks while helping you stay stable. MAT involves taking medications prescribed for treating opioid use disorder and slowly tapering off opioids.

3. Medication-Assisted Treatment Is the Gold Standard

People with OUD who receive treatment during pregnancy are less likely to deliver prematurely than those who don’t get treatment. Treatment also improves the chances of delivering a baby with a healthy birth weight.

MOUD is the most effective treatment for opioid dependence. Three types of MOUD are used for long-term treatment, but just two are typically prescribed during pregnancy.

Methadone and Buprenorphine May Be Used During Pregnancy

Methadone and buprenorphine are the preferred treatment options for pregnant people with OUD. These long-lasting opioids reduce the need for other opioids, without causing the same “high” as some of the more addictive ones. Both are well studied and considered safe when taken as prescribed. They can help reduce cravings, prevent withdrawal, and improve outcomes, making relapse less likely.

Naltrexone Typically Isn’t Recommended During Pregnancy

Naltrexone blocks the effects of opioids and can help reduce cravings. However, researchers and doctors don’t usually recommend starting this medication during pregnancy. Because withdrawal from opioids is required before taking naltrexone, it can be unsafe during pregnancy. In addition, naltrexone may make pain-relieving medications given during birth less effective.

Naloxone May Be Used in the Event of an Overdose

Naloxone (Narcan) is a lifesaving medication that can quickly block the effects of opioids. This medication isn’t a long-term treatment option, but it may be safely used during pregnancy in emergency situations, such as an overdose.

Level of Care Differs Among Treatment Programs

Treatment programs that provide MAT come in different formats. The right choice depends on your medical needs and lifestyle.

Outpatient programs let you live at home and continue daily activities while attending appointments for treatment and support. Inpatient programs provide more structure, with 24/7 care and supervision.

Both approaches can be effective. Working with your healthcare team and support system can help you decide which level of care is best for you.

4. Buprenorphine May Lead to Better Outcomes for the Baby Than Methadone

Both methadone and buprenorphine are safe and effective medications for substance use disorder during pregnancy. Research suggests that buprenorphine may be linked to better outcomes ​​​​​​​for the baby in some cases. Compared with methadone, buprenorphine has been associated with:

• Lower rates of preterm birth
• Higher birth weights and larger head circumferences
• Reduced risk and duration of NAS

The choice between these medications should be made with a healthcare professional. Factors such as access to treatment, medical history, and personal preference all play an important role.

5. NAS Is Treatable With the Right Pediatric Support

NAS is a relatively common ​​​​​​​but treatable condition in babies exposed to opioids during pregnancy. Treatment may include comfort measures like swaddling, extra fluids, and high-calorie formula.

In more severe cases, babies may need medication for a short period to ease symptoms. For example, methadone can ease NAS symptoms in babies exposed to opioids like heroin, fentanyl, or oxycodone. The dose is gradually reduced until the medicine is no longer needed.

Babies with NAS usually stay in the hospital for monitoring until the substance is no longer in their system. During this time, their feeding, sleep, and weight are checked.

Once your baby goes home, regular checkups help ensure they continue to recover and reach developmental milestones. If delays occur, your doctor might recommend early intervention therapies to help your child learn to walk, talk, and interact with others.

6. Collaboration With Your Healthcare Team Is Key

Stigma is a major barrier for pregnant people with OUD. Fear of judgment or legal consequences can make it harder to be open with doctors, which may delay or prevent treatment.

Being honest with your healthcare team can improve health outcomes for both you and your baby. Teams that may include obstetricians, addiction medicine specialists, and pediatricians can provide you with well-rounded care.

Mental health support is an important part of recovery during and after pregnancy. Many pregnant women with OUD have mental health disorders like depression, anxiety, or post-traumatic stress disorder (PTSD), according to the journal Substance Abuse and Rehabilitation. Counseling and support groups can provide mental health support and help with recovery.

People with OUD are at higher risk for infections such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV). During pregnancy, it’s especially important to talk with your healthcare provider about routine testing and treatments.

7. Postpartum Planning and Breastfeeding Support Matter

The weeks after birth can be a challenging time for recovery. The postpartum period is a vulnerable time. Relapse risk increases due to sleep deprivation and the stress of caring for a newborn. Ongoing treatment is important to prevent unintentional opioid overdose.

Recovery planning should include continued treatment with methadone or buprenorphine. Behavioral health support, like counseling and support groups, may be particularly helpful during this time. Setting small, realistic milestones can make recovery feel more manageable.

Breastfeeding is usually safe while taking buprenorphine or methadone. It may even lessen NAS symptoms for your baby and reduce the likelihood that your baby will need medication. Skin-to-skin contact can also comfort your baby and support bonding.

With compassionate care, safe treatment, and ongoing support, both you and your baby can have a healthier start.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

If you’ve experienced OUD during pregnancy, what kind of support made the biggest difference for you? What was your experience when taking buprenorphine or methadone during pregnancy? Let others know in the comments below.