Understanding Opioid Use Disorder (OUD) in Pregnancy: Common Questions & Answers
Opioid Use Disorder (OUD) during pregnancy is a critical and growing concern, affecting thousands of women and their babies each year. The prevalence of OUD in pregnancy has been rising, with about 8 out of every 1,000 deliveries diagnosed with this condition in 2017. This issue is even more pronounced among Medicaid recipients. Alarmingly, the number of fatal overdoses among pregnant women has doubled from 2007 to 2016, making it a leading cause of maternal mortality.
In this blog, we address some of the most common and pressing questions that clinicians and pregnant individuals face regarding OUD. By providing clear and straightforward answers, we hope to guide clinicians and offer reassurance to pregnant women managing OUD, ensuring the best possible outcomes for both mother and baby.
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Key Questions Clinicians Face in Managing OUD in Pregnancy
Question 1: “I want to stop my Suboxone. What are the risks and recommendations?”
Common Reasons for Wanting to Stop Buprenorphine-Based Treatment:
- Concerns about Neonatal Opioid Withdrawal Syndrome (NOWS) and potential suffering of the baby
- Fear of Child Protective Services (CPS) intervention.
Risks of Stopping OUD Medication-Assisted Treatment (MAT) During Pregnancy:
- Greatest concerns are a high risk of relapse and a high risk of overdose.
- Other risks associated with relapse during pregnancy include
- Poor engagement in prenatal care
- Higher risk of pregnancy and obstetric complications
- Risks associated with drug-seeking behavior
- Potential fetal risks with relapse include:
- Fetal distress
- Fetal growth restriction
- Preterm labor
- Meconium passage (a sign of fetal distress)
- Fetal death
- Placental abruption
Recommendations:
- Do not stop or reduce MAT during pregnancy
- Benefits of staying in treatment include:
- Higher engagement in prenatal care
- Lower risk of maternal, obstetric, and neonatal complications
Question 2: “Is Methadone a better medication than Buprenorphine in pregnancy?”
Comparison of Methadone and Buprenorphine
- Methadone: Traditionally considered the “gold standard” for managing OUD in pregnancy
- Buprenorphine: Allows for more take-home medications and has a lower risk of overdose
Efficacy and Safety
- Both medications are equally effective for managing OUD in pregnancy.
- Studies show Buprenorphine is associated with:
- Less need for morphine in babies with NOWS
- Shorter treatment duration for NOWS
- Fewer hospital days for neonates
- Lower frequency of NOWS compared to Methadone
Conclusion
- Both Methadone and Buprenorphine are recommended for pregnant individuals with OUD
- For women already stabilized on Buprenorphine, there is no need to switch to Methadone
- Conversely, those stabilized on Methadone should continue it throughout pregnancy
Question 3: “Should I be on Subutex (Buprenorphine) vs. Suboxone (Buprenorphine/Naloxone) during my pregnancy?”
Considerations
- Buprenorphine/naloxone is as safe and effective as buprenorphine mono-product for management of OUD in pregnancy and for the baby. In fact, some studies suggest a lower risk of NOWS with the combination buprenorphine/naloxone product.
Recommendations
Buprenorphine/naloxone is associated with lower risk of misuse, so is increasingly used in pregnancy. In our clinics we recommend using buprenorphine/naloxone (suboxone) over buprenorphine (Subutex) in pregnancy
Question 4: “Can I breastfeed if I am taking Suboxone?”
Yes, breastfeeding is safe when the mother is taking Suboxone:
- Buprenorphine is present in low levels in breast milk and has poor oral bioavailability in infants.
- Naloxone is excreted in minimal amounts and is not detectable in the plasma of breastfed infants.
ACOG Recommendations
- Encourage breastfeeding for women stable on opioid agonists, not using illicit drugs, and without contraindications (e.g., HIV infection).
- Suspend breastfeeding in the event of a relapse.
Question 5: “Now that I have a baby, I want to stop taking Suboxone. When can I stop?”
Postpartum Considerations
- The postpartum period involves significant stressors such as sleep deprivation, anxiety, relationship stress, and depression.
- ACOG and SAMHSA recommend continuing MAT after childbirth.
When it is Safe to Consider Tapering Off
- Baby is sleeping through the night
- Baby has weaned off breastfeeding
- Safe and stable home and social environment
- No major maternal mental health issues
- Tapering should be slow, with careful monitoring and support
Managing Opioid Use Disorder during pregnancy is crucial for the health of both the mother and the baby. If you or someone you know is struggling with OUD and pregnancy, it is vital to seek professional help and continue treatment.
At CleanSlate, we provide comprehensive, compassionate care tailored to your unique needs. Reach out to us today to learn more about how we can support you through your pregnancy and beyond. Your health and your baby’s well-being are our top priorities.
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