From the Guidelines
Medication-assisted treatment (MAT) with buprenorphine is considered the first-line treatment for opioid use disorder in pregnant females, due to its association with less severe neonatal abstinence syndrome and favorable maternal and newborn outcomes. Buprenorphine (typically 8-24 mg daily) should be initiated as soon as possible to prevent withdrawal, which can cause fetal distress and potential complications like preterm labor or fetal demise 1. The choice of buprenorphine over methadone depends on individual factors, such as a history of good past response to buprenorphine, availability of a buprenorphine prescriber, and inadequate response to methadone.
Some key points to consider when treating opioid use disorder in pregnant females with buprenorphine include:
- Buprenorphine is a partial mu-opioid receptor agonist that can be prescribed in an office-based setting, making it a more accessible treatment option for many patients 1
- Health-care providers who wish to prescribe buprenorphine must first complete a training program to obtain a waiver from the Drug Enforcement Administration 1
- Patients who receive buprenorphine should attend at least monthly counseling sessions to support their treatment 1
- Buprenorphine has been shown to be safe and effective in pregnancy, with favorable maternal and newborn outcomes compared to methadone 1
It's also important to note that methadone is still a viable treatment option for opioid use disorder in pregnant females, particularly for those with a history of successful use of methadone or severe opioid use disorder that would benefit from the structure of a methadone clinic 1. However, buprenorphine may be preferred in some cases due to its association with less severe neonatal abstinence syndrome and more favorable newborn outcomes. Ultimately, the choice between buprenorphine and methadone should be guided by individual patient factors and shared decision-making between the patient and healthcare provider 1.
From the Research
First Line Treatment of Opioid Use Disorder in Pregnant Females
- Medication-assisted treatment (MAT) with methadone or buprenorphine is considered the first line treatment for opioid use disorder in pregnant females 2, 3, 4, 5, 6
- Buprenorphine is often preferred over methadone due to its association with shorter treatment duration, less medication needed to treat neonatal abstinence syndrome (NAS) symptoms, and shorter hospitalizations for neonates 2, 5
- Methadone is a long-acting mu-opioid receptor agonist that has been shown to increase retention in treatment programs and attendance at prenatal care while decreasing pregnancy complications 4
- Naltrexone is not a first-line treatment primarily because both detoxification and an opioid-free period are required 2
- The decision to use methadone vs buprenorphine for MAT should be individualized based upon local resources and patient-specific factors 4
Key Considerations
- Medication increases may be needed with advancing pregnancy, and are not associated with more severe neonatal abstinence syndrome (NAS) 3
- Switching medication prenatally is usually not recommended as it can destabilize opioid abstinence 3
- Postnatally, breastfeeding is seen as beneficial for the infant for women who are maintained on a stable dose of opioid agonist medication 3
- NAS appears generally less severe following prenatal exposure to buprenorphine versus methadone 3