About Opioid Use During Pregnancy
Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as potential treatment options for opioid use disorder.
- Common prescription opioids include codeine, oxycodone, hydrocodone, and morphine.
- Fentanyl is a prescription synthetic opioid pain reliever. It can also be made illegally.
- Heroin is an illegal opioid.
What is opioid use disorder?
Opioid use disorder, 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.
What is medication-assisted treatment?
Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to treat opioid use disorders. Methadoneexternal icon and buprenorphineexternal icon are first-line therapy options for pregnant women with opioid use disorder
Opioid Use During Pregnancy
During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. As such, opioid use during pregnancy is not uncommon. According to 2019 self-reported data, about 7% of women reported using prescription opioid pain relievers during pregnancy. Of those, 1 in 5 reported misuse (meaning, getting them from a source other than a health care provider or using them for a reason other than to relieve pain).
There have been significant increases in opioid use disorder (see definition in box) during pregnancy. For example, the number of women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014.
Health Outcomes From Exposure During Pregnancy
Opioid exposure during pregnancy has been linked to some adverse health effects for both mothers and their babies. As an example, for mothers, opioid use disorder has been linked to maternal death1,2; for babies, opioid use disorder or long-term opioid use has been linked to poor fetal growth, preterm birth, stillbirth, specific birth defects, and neonatal abstinence syndrome (see below)3,4. The effects of prenatal opioid exposure on children over time are largely unknown. In some cases—such as the treatment of opioid use disorder during pregnancy—continued use of opioid medications as prescribed outweighs the risks. Women should consult their physician before stopping or changing any prescribed medication.
Neonatal Abstinence Syndrome (NAS)
American Academy of Pediatrics (AAP)
Clinical Report: Neonatal Opioid Withdrawal Syndromeexternal icon
Released November 2020 in Pediatrics
Opioid use and medication-assisted treatment for opioid use disorder 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. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Signs of withdrawal usually begin within 72 hours after birth and may include the following:
- Tremors (trembling)
- Irritability, including excessive or high-pitched crying
- Sleep problems
- Hyperactive reflexes
- Yawning, stuffy nose, or sneezing
- Poor feeding and sucking
- Loose stools and dehydration
- 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 (e.g., alcohol5, tobacco5,7, other medications5-8) before birth.
Birth outcomes associated with opioid use during pregnancy
Infants exposed to opioids during pregnancy might be more likely to
- Be born preterm (born before 37 weeks of pregnancy);
- Have poor fetal growth;
- Have longer hospital stays after birth;
- Be re-hospitalized within 30 days of being born; and
- Be born with birth defects.
Longer-term developmental outcomes associated with opioid use during pregnancy
There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes not obvious at birth. Results from a recent studyexternal icon suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findingsexternal icon about the long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.
Treatment for Opioid Use Disorder Before, During, and After Pregnancy
If a woman is pregnant or planning to become pregnant, the first thing she should do is talk to a healthcare provider. Creating a treatment plan for opioid use disorder, as well as other co-occurring health conditions, before pregnancy can help a woman increase her chances of a healthy pregnancy.
Quickly stopping opioids during pregnancy is not recommended, as it can have serious consequences, including preterm labor, fetal distress, or miscarriage. Current clinical recommendationsexternal icon for pregnant women with opioid use disorder include medication-assisted treatment (MAT), rather than supervised withdrawal, due to a higher likelihood of better outcomes and a reduced risk of relapse.
It is important to recognize that NAS is an expected condition that can follow exposure to MAT. A concern for neonatal abstinence syndrome alone should not deter health care providers from prescribing MAT. Close collaboration with the pediatric care team can help ensure that infants born to women who used opioids during pregnancy are monitored for NAS and receive appropriate treatment, as well as be linked to needed services.
Support for women in treatment for opioid use disorder is critical in the postpartum period—a time of adjustments and increased stressors—which may increase the risk for relapse and overdose events. Data suggest that some women with opioid use disorder are not diagnosed until delivery or the postpartum period. Continued access to health care and linkage to care for substance use disorders and other co-occurring conditions is important. Women with opioid use disorder during pregnancy should continue MAT as prescribed in the postpartum period. Learn more about treatment for opioid use disorder for women before, during, and after pregnancy.
For additional resources, visit CDC’s opioid webpages:
- Rx Awareness Treatment and Recovery
- Opioid Basics
- Pregnancy and Opioid Pain Medications (English pdf icon[PDF – 0.99 MB]] [Spanish pdf icon[PDF – 223 KB])
Find More Information
For information about the risks of specific opioid medications used during pregnancy, read MotherToBaby’s fact sheetsexternal icon. 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,
- Call 1-866-626-6847
- Chat live online via the MotherToBaby websiteexternal icon
- Send an email via the MotherToBaby websiteexternal icon
- Find a Health Center for Substance Abuse Servicesexternal icon
- Findtreatment.govexternal icon
- Locator for physicians providing buprenorphine for opioid use disorderexternal icon
- Locator for programs providing methadone for opioid use disorderexternal icon
- Metz TD, Rovner P, Hoffman MC, et al. Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstet Gynecol. 2016;128:1233-40.
- 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.
- 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.
- 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; DOI: https://doi.org/10.1542/peds.2016-4131
- 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. doi: 10.1136/bmj.h2102
- 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. http://dx.doi.org/10.1136/bmj.j3326external icon
- Patrick SW, Dudley J, Martin PR, et al. Prescription Opioid Epidemic and Infant Outcomes. Pediatrics 2015;135(5):842-50.
- 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.