Opioid Abuse During Pregnancy

By Temma Ehrenfeld @temmaehrenfeld
September 19, 2023
Opioid Abuse During Pregnancy

The number of newborns affected by their mother’s opioid abuse during pregnancy is growing. Six of every 1,000 babies need detox. Here's what you should know.

Opioid abuse — now called opioid use disorder — has become a problem for babies. If a mother takes a drug while she’s pregnant, her baby may need the drug at birth.

The number of newborns born suffering the effects of opioid withdrawal in the hospital nearly doubled between 2010 and 2017, with some hard-hit states like West Virginia and Maine seeing much sharper increases.

Drug overdose deaths among pregnant and postpartum women also nearly doubled, between 2017 and 2022. In the most recent data from the Centers for Disease Control and Prevention, deaths related to mental health, including substance abuse, accounted for a quarter of deaths during pregnancy or in the next year — more than bleeding, heart disease, or other pregnancy complications.

That doesn’t mean opioids should be ruled out for pregnant women, according to the American College of Obstetricians and Gynecologists (ACOG). The group advises its members to explain the risks to patients and check the records of the Prescription Drug Monitoring Program (which should indicate whether a patient has received painkiller prescriptions from other doctors).


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Neonatal abstinence syndrome

A baby going through withdrawal, called neonatal abstinence syndrome, is more irritable, has a high-pitched cry, and has trouble sucking to feed. Smoking, standard SSRI antidepressants, and benzodiazepines like Klonopin or Ativan may make withdrawal harder for your baby as well.

Withdrawal symptoms from buprenorphine begin within 48 to 72 hours following birth and typically end within a week. With methadone, they can last longer. But the symptoms can be treated and may not even require medication.

Be frank with your doctor

If you’re pregnant or tell your doctor you’re trying, expect to be asked about your alcohol and drug habits. You should be upfront about opioid abuse during pregnancy.

In many states, your doctor will need your written consent to disclose any information about you.

You can safely ask for help with substance abuse care. Several states have treatment programs for pregnant women or give them quicker access to care. See the Substance Abuse and Mental Health Services Administration’s website for a list of local programs.

About half of the states and the District of Columbia consider substance use during pregnancy to be child abuse, requiring healthcare professionals to report suspected prenatal drug use. You can look up your state here.

If your child is born with signs of withdrawal, your doctors will suspect you. Being in treatment is not considered substance use. That’s one strong argument to get help right away.

The sad truth is that at least half of foster care placements in recent years are linked to parental substance use.

Methadone or buprenorphine?

If you are addicted to any opioid, the ACOG recommends taking medication like methadone or buprenorphine rather than trying to withdraw under medical supervision. There is no clear evidence that a medically supervised withdrawal will hurt your baby, but trying to quit opioids without medication is difficult — from 60 to 90 percent of patients relapse.

Methadone has a higher success rate for beating the problem, but buprenorphine seems safer for babies, according to a study based on a large national 18-year database. That result is consistent with research in Rhode Island and elsewhere.  

Methadone or buprenorphine can help you, along with counselling and other services, avoid pregnancy complications.

According to the ACOG, after “many years of research, opioid replacement medication has not been found to cause birth defects.” There is some evidence of long-term effects of neonatal abstinence syndrome, however. The worst thing you can do is leave an opioid problem untreated and expose your baby to the dangers that come with illegal drug use.

It’s easier to get buprenorphine, which can be prescribed in a doctor’s office.

To get methadone regularly, you’ll need to participate in a drug treatment program. If you go on methadone, the dosage may need to be adjusted while you are pregnant to help you avoid drug cravings and the abdominal cramps, nausea, insomnia, irritability, and anxiety that can come with withdrawal.

Those symptoms also can distress your baby. There is no good evidence that a smaller dose will help a child adjust after birth, according to the ACOG.

The U.S. Food and Drug Administration has approved a long-acting buprenorphine implant that provides low-to-moderate doses of buprenorphine for up to six months, but there’s no data on the use of the implant in pregnant women.

Buprenorphine is sometimes combined with naloxone. The ACOG advises its members about research that found that the combination is safe for pregnant women, but questions remain about the effect of naloxone on the fetus.

You can and should get extra pain relief during labor and stay on your medication. You may be more sensitive to pain and less responsive to painkillers during labor and birth, but you’re likely to be able to stay on your current medication dose post-delivery, whether you’re taking methadone or buprenorphine.

You also can and should breastfeed while taking your medication, unless you have other reasons not to breastfeed. Very little medication will reach your child. Be careful about medicines containing codeine or tramadol and any medicine that makes people sleepy, including antihistamines and benzodiazepines like Ativan.

It is more common for women to relapse after the birth than during pregnancy. You may be triggered by lack of sleep, fear of losing custody, or postpartum depression. Be sure that you or someone you trust has naloxone available to save you in an overdose.

Also consider getting an IUD so you don’t run the risk of getting pregnant unintentionally, especially if your recent pregnancy wasn’t planned.

Get the help you need to enjoy and love your baby, a bright new beginning for you. 


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September 19, 2023

Reviewed By:  

Christopher Nystuen, MD, MBA and Janet O'Dell, RN