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Effects of Suboxone Use by Pregnant Women

couple holding pregnant bellySuboxone consists of both buprenorphine (which can decrease opioid cravings, lessen withdrawal from opioids, and diminish other opioids’ effects) and naloxone (which may deter a person from snorting or injecting Suboxone).1,2 After birth, a newborn might experience neonatal opioid withdrawal syndrome if the mother used Suboxone during pregnancy, but this is treatable.1 There is not expert consensus on if the child can have persisting developmental problems or other issues because of methadone, combined buprenorphine and naloxone, or buprenorphine exposure before birth.3 However, if a woman’s opioid use disorder is not treated while she is pregnant, the ramifications for her baby can be severe, even deadly.4

Both behavioral interventions that are based on evidence and buprenorphine or methadone treatment should be offered to women who have an opioid use disorder and are pregnant. If a pregnant woman is already taking Suboxone, the healthcare provider and woman should weigh the risks and benefits to both the mother and child and, based on that, determine whether the woman will, while pregnant, take the combination of buprenorphine and naloxone or switch to only buprenorphine.3

What Does Suboxone Do?

Suboxone is a medication consisting of both buprenorphine and naloxone. It is a Schedule III medication that can be used to treat dependence on opioids.1

Buprenorphine can:2

Research has found connections between buprenorphine and lower likelihood of death from overdose. However, overdose can still occur, including overdosing on buprenorphine, which may be deadly.2

Naloxone prevents opioids from activating opioid receptors. Naloxone’s bioavailability is poor when taken orally, sublingually (under the tongue), or buccally (in the cheek), but if a person snorts or injects it, absorption occurs. When a product combines buprenorphine and naloxone, the naloxone may deter a person from snorting or injecting the medication. However, misuse can still occur.2

In addition to Suboxone, the combination of buprenorphine and naloxone is available as a generic and as the products Bunavail and Zubsolv.2

Is Suboxone Safe during Pregnancy?

Pregnant patients or patients who intend to get pregnant should alert their healthcare provider prior to taking Suboxone. There is a possibility of the child experiencing neonatal opioid withdrawal syndrome (NOWS) after the child is born if the mother took Suboxone when pregnant.1

If NOWS is not addressed, the baby’s life may be in danger. Thankfully, NOWS is treatable.1

Some of the signs of NOWS may include: 1

  • High pitched crying
  • Irritability
  • Not gaining weight
  • Diarrhea
  • Vomiting
  • Shaking

Neonatal abstinence syndrome (NAS) is a more general term. NAS is when, soon after birth, a collection of withdrawal signs arises in a baby who had exposure before birth to substances that are psychotropic. NAS includes opioid withdrawal in newborns who had exposure to opioids before they were born, but NOWS is a less broad term since it refers only to that.3

There is not a consensus among experts on if enduring developmental problems or other issues can occur due to methadone, combined buprenorphine and naloxone, or buprenorphine exposure in utero.3 There are limited data on buprenorphine use while pregnant.1 Based on research findings, it is not thought, though, that buprenorphine raises the likelihood of birth defects or major malformations.1,3

Is It Safer Than Other Options During Pregnancy?

The baby can suffer severe repercussions if, while the mother is pregnant with the baby, her opioid use disorder is not treated. Death of the unborn baby, fetal convulsions, early labor, and NAS are some of the risks.4

NAS may be less likely, NAS may be not as severe, and treatment may be briefer for babies whose mothers had buprenorphine or methadone treatment, compared to those whose mothers were not treated while pregnant. These babies also may weigh more at birth, may have bigger head circumferences when born, and may be born at greater gestational ages.4

It is highly recommended that women with opioid use disorders who are also pregnant receive treatment with medication. Medication-assisted treatment that involves behavioral interventions that are based on evidence as well as buprenorphine or methadone treatment should be offered.3

For women who are early in pregnancy, or plan to get pregnant, and are taking the combination of buprenorphine and naloxone to treat opioid use disorder, there is not a consensus among experts on whether prescribers should shift them to only buprenorphine instead of the combination. Weighing the risks and benefits to both the mother and child should form the basis for the determination by the healthcare provider and pregnant woman of whether the woman will take the combination of buprenorphine and naloxone while pregnant.3

Can a Pregnant Woman Detox?

It is not advised that women who are pregnant and have opioid use disorders undergo medically supervised opioid withdrawal. High relapse rates are connected with it, and relapse can result in overdose or death.3

Aspiring to decrease her baby’s NAS risk or to lessen how severe NAS will be if her baby experiences it, an individual might, while pregnant, want her methadone or buprenorphine dose to be lower; however, research has not found the severity or expression of an infant’s neonatal abstinence syndrome to be linked to the mother’s methadone or buprenorphine dose while she is pregnant.3

If you are using any illegal substances or misusing any legal substances, ask a healthcare provider right away for guidance on stopping use/misuse. It might be unsafe and/or less effective to try to stop without professional help. Even if you are not misusing any legal substances and not using any illegal ones, if you are, could be, or may get pregnant and are taking any supplements or medications (prescription or over-the-counter), immediately ask a healthcare provider if you should continue taking each medication/supplement. Make sure healthcare providers you see know all medications, supplements, and other substances you use; all your past or present health conditions; if you are, could be, or may become pregnant; and all other relevant information so they can give you appropriate care and guidance.

Sources

  1. Indivior Inc. (2018). LABEL: SUBOXONE – buprenorphine hydrochloride, naloxone hydrochloride film, soluble.
  2. Substance Abuse and Mental Health Services Administration. (2018) Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families.
  3. Substance Abuse and Mental Health Services Administration. (2018). Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants.
  4. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2017). Treating Opioid Use Disorder During Pregnancy.

 

About The Contributor
Sophie Stein, MSN
Clinical Editor, American Addiction Centers
Sophie Stein is a Clinical Editor at American Addiction Centers. She received her Master of Science in nursing from Vanderbilt University School of Nursing. Sophie previously worked as a psychiatric-mental health nurse practitioner at an... Read More