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. 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.
Clinical guidance for pregnant women with opioid use disorder is available from the American College of Obstetricians and Gynecologists (ACOG)external icon and the Substance Abuse and Mental Health Services Administration (SAMHSA)pdf iconexternal icon. As noted in their recommendations, 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, rather than supervised withdrawal, due to a higher likelihood of better outcomes and a reduced risk of relapse.
Medication-Assisted Treatment (MAT) During Pregnancy
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.
Methadoneexternal icon and buprenorphineexternal icon are first-line therapy options for pregnant women with opioid use disorder. SAMHSA and the ACOG recommend treatment with methadone or buprenorphine for pregnant women with opioid use disorder, in conjunction with behavioral therapy and medical services. Combination pills containing both buprenorphine and naloxone are not recommended for treatment of opioid use disorder in pregnant women, due to limited evidence at this time. While some treatment centers use naltrexone to treat opioid use disorder in pregnant women, 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 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 obstetrician-gynecologist (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 neonatal abstinence syndrome (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 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).
Plans of Safe Care
Families and caregivers with an infant who is affected by NAS and other prenatal substance exposure should be provided with a Plan of Safe Care. The objectives of the plans include strengthening the family, optimizing the child’s safety, and linking the family with services and other supports in their community. This plan is individually designed for each infant and caregiver to identify and outline a plan to address the needs of the infant (for example, services and supports available to meet health and developmental needs) and the caregiver and family (for example, substance use treatment). Plans can specify agencies within the community that provide services and can help guide communication and coordination.
Treatment for Mothers with Opioid Use Disorder After Delivery
Support for women with opioid use disorder is critical in the postpartum period, which is a time of many adjustments, including sleep deprivation and the demands of caring for a newborn.
As recommended by SAMHSA and ACOG, women with opioid use disorder should continue MAT as prescribed in the postpartum period. Healthcare providers should monitor women for potential signs or symptoms of sedation, in order to modify dosage if appropriate. Discontinuation of MAT for opioid use disorder should generally be avoided in the immediate postpartum period. However, it may be considered at a later time if the mother is stable and the mother and child are well-bonded and have a safe and stable home and social environment. Pharmacotherapy for opioid use disorder should be discontinued only with medical supervision and only when it is in the best interest of the mother and infant.
Screening for Other Mental Health Conditions
Women with opioid use disorder may also have other mental health conditions, including depression and anxiety. They should receive recommended screening for depression as well as other mental health conditions. Access to appropriate psychosocial support should be available.