Opioid Maintenance In Pregnancy : Information for Patients and Providers

There are several options for treatment of opioid addiction during pregnancy. The ones of importance include: methadone in pregnancy, Suboxone (buprenorphine/naloxone) in pregnancy, and buprenorphine alone during pregnancy. This is an important topic for mothers who have an opioid addiction and face the choice of whether to continue their opioid maintenance treatment during their gestation or whether to discontinue the medication. As always, only individualized treatment with your own physician can adequately assess your situation and the following are general guidelines.

The current thinking for mothers with an opioid addiction is to continue their maintenance medications.

Suboxone carries a Pregnancy Category C indication by the FDA which means that a risk to the fetus can\’t be ruled out. Since Suboxone is a combination of buprenorphine and naloxone, mothers are many times switched to buprenorphine alone (Brand name Subutex) to decrease exposure to one medication rather than two.

There are a number of risks to discontinuing the methadone, Suboxone, or buprenorphine. The main concern is the risk of the mother going back to using illicit drugs. If this happens, the fetus will be exposed to cycles of the mother getting on and off the drug based on what they can obtain on the streets. The fetus may also get exposed to HIV as drug use and promiscuity are related. The mother is less likely to receive proper healthcare for herself or the fetus, resulting in premature birth, low birthrate children, and the possibility the child will be removed from the home eventually.

It is believed that because of these risks, the majority of opioid dependent mothers should maintained on their medication through pregnancy and after. There there is a 30-40% chance the newborn will undergo an abstinence syndrome at birth, but this is easily managed with proper warning to the treatment team before the birth. Buprenorphine appears to carry a lower risk of neonatal abstinence syndrome compared to methadone. Since there is minimal drug in the breast milk, mothers are allowed to breastfeed.

The American Psychiatric Association sponsors webinars on buprenorphine treatment and the latest update on pregnancy can be viewed here. The webinars are primarily designed for healthcare providers, but have great value in answering questions