Basics 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 her potential treatment options for opioid use disorder.
- Common prescription opioids are 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.
Opioid Use during Pregnancy
Opioid use in women aged 15–44 years has increased over time. This increase is similar to the dramatic increase in overall use in the United States. 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.
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 negative health effects for both mothers and their babies. These include maternal death and poor fetal growth, preterm birth, stillbirth, possible specific birth defects, and neonatal abstinence syndrome (see below). The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and outweigh the risks of these potential negative health outcomes.
Neonatal Abstinence Syndrome (NAS)
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). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include
- 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 symptoms a newborn might experience, and how severe the symptoms 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 more than one substance 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
- Possibly 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 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 and During Pregnancy
If a woman is pregnant or planning to become pregnant, the first thing she should do is talk to a healthcare provider. Some women need to take an opioid medication during pregnancy to manage pain or to treat opioid use disorder. 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 recommendations for pregnant women with opioid use disorder include medication-assisted treatment (MAT), rather than supervised withdrawal, due to higher likelihood of better outcomes.
Medication-assisted treatment (MAT)
Medication-assisted treatment (MAT) uses a combination of medications, counseling, and behavioral therapies to treat substance use disorders. This treatment combination can lead to more favorable outcomes.
Common medications used in MAT are methadoneexternal icon, buprenorphineexternal icon, and naltrexoneexternal icon. The Substance Abuse and Mental Health Services Administration pdf icon[PDF – 2.6 MB]external icon (SAMHSA) and the American College of Obstetricians and Gynecologistsexternal icon (ACOG) recommend treatment with methadone or buprenorphine (without naloxone) for pregnant women with opioid use disorder, in conjunction with behavioral therapy and medical services. Currently, information on the safety of naltrexone during pregnancy is limited.
Pregnant women with opioid use disorder should be encouraged to start MAT with methadone or buprenorphine (without naloxone). Like many medications taken during pregnancy, MAT has unique benefits and risks to pregnant women and their babies. It is important for healthcare providers to work closely with pregnant women to manage the medical care for both mother and baby during pregnancy and after delivery. Coordination of care between an OB-GYN and an addiction specialist is important for pregnant women with opioid use disorder. Pregnant women with opioid use disorder may also seek care from OB-GYNs and other primary care providers who have additional training on addiction treatment.
It is important to recognize that NAS is an expected condition that can follow exposure to MAT. Infants born to women who use opioids during pregnancy should be monitored for NAS, and treated.
Talk with your healthcare provider to learn more about treatment options for opioid use disorder during pregnancy.external icon
If you or someone close to you needs help for a substance use disorder, talk to a healthcare provider or call SAMHSA’s National Helplineexternal icon at 1-800-662-HELP (4357).
For additional resources, visit CDC’s Opioid webpages:
For information about the risks of specific opioid medications used during pregnancy, read MotherToBaby’s factsheetsexternal 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