Treatment of Opioid Use Disorder Before, During, and After Pregnancy

Treatment overview

Creating a treatment plan for opioid use disorder (OUD) may include a medication for OUD such as methadone or buprenorphine. Making a plan before pregnancy can help increase the chances of a healthy pregnancy.

Clinical guidance for pregnant people with OUD is available from the American College of Obstetricians and Gynecologists (ACOG) and the Substance Abuse and Mental Health Services Administration (SAMHSA). As noted in these recommendations, quickly stopping opioids during pregnancy is not recommended.

Quickly stopping opioids during pregnancy can have serious consequences, including

• Preterm labor
• Fetal distress
• Miscarriage

Current clinical recommendations for pregnant people with OUD include medication for opioid use disorder (MOUD), rather than supervised withdrawal. MOUD has a higher likelihood of better outcomes and a reduced risk of relapse.

Medication for opioid use disorder (MOUD) during pregnancy

Medication for opioid use disorder (MOUD) refers to the use of medication to treat opioid use disorder. This type of treatment can lead to more favorable outcomes.

Methadone and buprenorphine are first-line therapy options for pregnant people with OUD. ACOG and SAMHSA recommend treatment with methadone or buprenorphine for pregnant people with OUD, in conjunction with behavioral therapy and medical services.

While some treatment centers use naltrexone to treat OUD in pregnant people, current information on its safety during pregnancy is limited. ACOG recommends that if a woman is stable on naltrexone prior to pregnancy, the decision regarding whether to continue naltrexone treatment during pregnancy should involve a careful discussion between the provider and the patient, weighing the limited safety data on naltrexone with the potential risk of relapse with discontinuation of treatment.

Pregnant people with OUD should be encouraged to start treatment with methadone or buprenorphine. Like many medications taken during pregnancy, MOUD has unique benefits and risks to pregnant women and their babies.

It is important for healthcare providers and people who are pregnant with OUD to work together to manage medical care during pregnancy and after delivery. Coordination of care between a prenatal care provider and a specialist with expertise in opioid use is important for pregnant people with OUD.

It is important to recognize that neonatal abstinence syndrome (NAS) is an expected condition that can follow exposure to MOUD. A concern for NAS alone should not deter healthcare providers from prescribing MOUD. Close collaboration with the pediatric care team can help ensure that infants born to people who used opioids during pregnancy are monitored for NAS and receive appropriate treatment, as well as be referred to needed services.

Talk with your healthcare provider to learn more about OUD treatment options during pregnancy.

Treatment for people with OUD after delivery

Support for people with OUD is important after the baby is born. People may be adjusting to many new factors in their lives. For example, they may experience a lack of sleep and anxiety about the demands of caring for a newborn.

According to ACOG and SAMHSA, people with OUD should continue MOUD as prescribed after the baby is born. Healthcare providers should monitor people during this time and adjust the dosage if needed.

Discontinuation of MOUD for OUD should generally be avoided in the time immediately after the baby is born. At the very least, it should be avoided until the baby is consistently sleeping through the night and has completed breastfeeding.

However, ending MOUD later may be considered if the mother and child are:

• Stable.
• Well-bonded.
• Safe and have a stable home and social environment.

This should only be done with medical supervision and in the best interest of the mother and child.

Plans to stop MOUD should be made together with the healthcare team. MOUD must be reduced slowly to prevent withdrawal. A safety plan for the mother and family needs to be in place before slowly stopping MOUD, so that plans are in place if opioid relapse occurs. People can safely continue MOUD for as long as they need it. This can range from a month to a lifetime of MOUD.

Other mental health conditions

People with OUD may also have other mental health conditions, including depression and anxiety. They should receive recommended screening and treatment.