About Opioid Use During Pregnancy

Key points

  • Opioid use during pregnancy can affect parents and their babies.
  • Opioids are a class of drugs used to reduce pain.
  • It is important for people to be aware of the possible risks of opioid use during pregnancy, as well as treatment options including medication for opioid use disorder.
crying baby

Overview

Opioid use during pregnancy can affect parents and their babies. Pregnant people may use opioids as prescribed, may misuse prescription opioids, or may use illicit opioids such as heroin. It is important for people to be aware of the possible risks of opioid use during pregnancy, as well as treatment options including medications for opioid use disorder.

Opioids may also be used in combination with other substances. Use of more than one substance, also called polysubstance use, during pregnancy is common. Though the effects of polysubstance use on a developing baby are not well known, substance use during pregnancy can have various effects on a developing baby.

Terms to know

Opioids

Opioids are a class of drugs used to reduce pain. A few examples of opioids are as follows:

  • Common prescription opioids include, oxycodone, hydrocodone, morphine, and methadone.
  • Fentanyl is a prescription synthetic opioid pain reliever. It can also be made illegally.
  • Heroin is an illegal opioid.
  • New synthetic substances are constantly introduced into the supply of illicit drugs. These new synthetic substances may not be detected with existing laboratory tests and people who are taking them may not be aware of it.

Opioid use disorder (OUD)

Opioid use disorder (OUD), sometimes referred to as opioid addiction, is a problematic pattern of opioid use that causes significant impairment or distress. It was previously classified as opioid abuse or opioid dependence in DSM-IV criteria.

Medication for Opioid Use Disorder (MOUD)

Medication for Opioid Use Disorder (MOUD) refers to the use of medication to treat opioid use disorder. Methadone and buprenorphine are the primary medications for pregnant people with OUD.

Neonatal abstinence syndrome (NAS)

NAS is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth.

Neonatal opioid withdrawal syndrome (NOWS)

NOWS is withdrawal among newborns during the first 28 days of life due to long-term exposure to opioids before birth. NOWS is a subset of NAS and is specific to opioid withdrawal during the first 28 days of life. Opioids given at the time of delivery do not cause NOWS.

Health outcomes from exposure during pregnancy

Opioid exposure during pregnancy has been linked to poor health for both mothers and babies. Opioid use disorder (OUD) has been linked to

The effects of prenatal opioid exposure on children over time are largely unknown, including among those with or without neonatal abstinence syndrome (NAS). Not all babies exposed to opioids during pregnancy experience signs of NAS, but there could be long-term effects on development that aren't obvious at birth. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

Taking MOUD as prescribed during pregnancy has benefits that outweigh the risks. It is important for healthcare providers and people who are pregnant to work together to manage medical care, including substance use, during pregnancy and after delivery. Pregnant people should consult their physician before stopping or changing any prescribed medication.

Healthcare provider talking to pregnant patient.
It is important for healthcare providers and pregnant patients to work together to manage medical care.

Neonatal abstinence syndrome (NAS)

Opioid use during pregnancy can lead to neonatal abstinence syndrome (NAS) in some newborns. NAS is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth.

Signs of withdrawal usually begin within 72 hours after birth and may include the following:

  • Tremors (trembling) or seizures
  • Sleep problems or irritability, including excessive or high-pitched crying
  • Hyperactive reflexes
  • Yawning, stuffy nose, or sneezing
  • Poor feeding and sucking
  • Loose stools and dehydration or vomiting
  • Increased sweating

The signs a newborn might experience, and how severe the signs will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to other substances (for example, alcohol5, tobacco567, other medications5678) before birth.

Quick facts and stats

Opioid use during pregnancy

According to 2019 self-reported data, about 7% of women reported use of prescription opioid pain relievers during pregnancy. Of those, 1 in 5 reported misuse (defined by this survey as getting prescription opioid pain relievers from a source other than a healthcare provider or using them for a reason other than to relieve pain).9

Diagnoses at delivery

In the most recent estimate available, the number of women with opioid-related diagnoses documented at delivery increased by 131% from 2010 to 2017.10

Neonatal abstinence syndrome

According to 2020 data from the Healthcare Cost and Utilization Project (HCUP), about 6 newborns were diagnosed with neonatal abstinence syndrome (NAS) for every 1,000 newborn hospital stays. That is about 1 baby diagnosed with NAS every 24 minutes in the United States, or more than 59 newborns diagnosed every day.

The number of babies born with NAS in the United States increased by 82% from 2010 to 2017. Increases were seen for nearly all states and demographic groups. The occurrence of NAS diagnoses per 1,000 newborn hospital stays ranged from 1 in Hawaii to 43 in West Virginia.

To learn more, use this interactive map of NAS to search by state.

Resources

CDC resources

More information

For information about the risks of specific opioid medications used during pregnancy, read MotherToBaby's fact sheets. MotherToBaby experts are also available by phone or online chat to answer questions in English or Spanish. This free and confidential service is available Monday through Friday from 8 a.m. to 5 p.m. (local time). To reach MotherToBaby,

Find treatment

Print
Content Source:
National Center on Birth Defects and Developmental Disabilities (NCBDDD)
  1. Metz TD, Rovner P, Hoffman MC, et al. Maternal deaths from suicide and overdose in Colorado, 2004–2012. Obstet Gynecol. 2016;128:1233–40.
  2. Smid MC, Stone NM, Baksh L, et al. Pregnancy Associated Death in Utah: Contribution of Drug-Induced Deaths. Obstet Gynecol. 2019;133(6):1131–40.
  3. Yazdy MM, Desai RJ, Brogly SB. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. J Pediatr Genet. 2015;4(2):56–70.
  4. Lind JN, Interrante JD, Ailes EC, et al. Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review. Pediatrics 2017;139(6):e20164131.
  5. Desai RJ, Huybrechts KF, Hernandez-Diaz S, et al. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: Population-based cohort study. BMJ 2015;350:h2102.
  6. Huybrechts KF, Bateman BT, Desai RJ, et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: Cohort study. BMJ 2017;358:j3326.
  7. Patrick SW, Dudley J, Martin PR, et al. Prescription Opioid Epidemic and Infant Outcomes. Pediatrics 2015;135(5):842–50.
  8. Sanlorenzo LA, Cooper WO, Dudley JA, et al. Increased Severity of Neonatal Abstinence Syndrome Associated with Concomitant Antenatal Opioid and Benzodiazepine Exposure. Hospital Pediatrics. 2019;9(8):1–7.
  9. Ko JY, D'Angelo DV, Haight SC, et al. Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019. MMWR Morb Mortal Wkly Rep 2020;69:897–903. Online version.
  10. Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA. 2021;325(2):146–155. Online version.
  • Patrick SW, Barfield WD, Poindexter BB, et al. Neonatal Opioid Withdrawal Syndrome. Pediatrics 2020;e2020029074.