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Buprenorphine substitution therapy of opioid use disorder during pregnancy

Vincenzo Berghella, MD
Neil S Seligman, MD
Brian J Cleary, PhD
Section Editors
Lynn L Simpson, MD
Andrew J Saxon, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Illicit opioid use during pregnancy is associated with substantial maternal, fetal, and neonatal risks. (See "Substance misuse in pregnant women", section on 'Opiates'.) Some of these risks are related to repeated opioid exposure and withdrawal, while others are related to factors associated with substance abuse (eg, smoking, poor nutrition, needle sharing). The rationale for opioid-substitution therapy during pregnancy is to reduce these risks by preventing complications associated with illicit opioid use and narcotic withdrawal, facilitating prenatal care and drug treatment, reducing drug-related criminal activity, and helping the patient avoid the myriad of other risks associated with the drug culture [1,2].

Comprehensive opioid-substitution therapy that includes prenatal care reduces the risk of obstetric and neonatal complications [1,2]. While methadone remains the standard choice for opioid agonist therapy during pregnancy, there is increasing interest in the use of buprenorphine because neonatal withdrawal appears to be less frequent and less severe [3].

This topic will discuss the use of buprenorphine for opioid substitution during pregnancy. General issues related to prevalence, screening, complications, and care of the pregnant opioid user and methadone maintenance therapy in pregnancy are reviewed separately. (See "Substance misuse in pregnant women", section on 'Opiates' and "Methadone substitution therapy of opioid use disorder during pregnancy".)


Pregnant women with substance dependence (table 1) are candidates for opioid-substitution therapy, regardless of the duration of dependence if a return to dependence is likely during pregnancy. (See "Clinical assessment of substance use disorders" and "Pharmacotherapy for opioid use disorder".)

Candidates for treatment should be referred to a local physician and/or substance use disorders treatment program that specializes in opioid substitution therapy. Treatment programs that are oriented to abstinence only and do not utilize or understand opioid substitution therapy should be avoided. In addition, prenatal care should be arranged.

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Literature review current through: Sep 2017. | This topic last updated: Aug 24, 2017.
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