Many women become pregnant while dealing with substance use disorder, which naturally sounds off alarm bells of worry and anxiety. However, even unplanned pregnancies can be exciting despite imperfect circumstances. Many women struggling with addiction see this event as an opportunity to turn their lives around. Fortunately, advances in addiction science have made it safer for pregnant women to get help for opioid use disorder through medication-assisted treatment and FDA-approved drugs. This means they have better options for support during their pregnancy.
Buprenorphine, an FDA-approved partial opioid agonist, reduces opioid cravings by binding to brain receptors and calming their signals that trigger drug-seeking behavior. Buprenorphine is a safer opioid medication than full opioid agonists because it only partially activates opioid receptors. It can also be prescribed as Subutex.
Due to a potential risk of buprenorphine misuse by patients, doctors often combine this medication with another called naloxone. This is an opioid antagonist that binds strongly to receptors in the brain. Naloxone has the ability to prevent buprenorphine or other opioids from binding to receptors if it’s injected due to its oral bioavailability. It will cause an immediate withdrawal reaction in the patient if used intravenously, deterring them from misuse. Buprenorphine and naloxone combined is most commonly known as the medication Suboxone.
Previously, doctors preferred to only prescribe buprenorphine to pregnant mothers, excluding naloxone, as they were not yet sure of its effects on the fetus. Since then, studies and tests have been conducted that indicate the use of buprenorphine and naloxone together can be used safely for both pregnant women and their babies. The combined drug featuring naloxone has the advantage of preventing relapse overdoses. This is a risk often faced by individuals who abruptly cease opioid misuse and enter treatment. There has also been evidence that the addition of naloxone can prevent neonatal abstinence syndrome or significantly reduce the risk and severity.
A recent study at Stanford Medicine found that pregnant mothers who used buprenorphine for their opioid use disorder had infants with better health outcomes than those with alternative treatments. John Hopkins trials also found that infants exposed to buprenorphine had greater birth weights and required less hospitalization on average. Overall, the benefits of taking buprenorphine and naloxone far outweigh the potential risks of maternal and fetal complications from leaving opioid use disorder untreated or using inferior methods.
Opioid dependency can be treated with buprenorphine and naloxone during pregnancy, but recovery is often a lengthy process. Pregnant mothers enrolled in medication-assisted treatment are urged to attend substance use counseling regularly. Counseling is a crucial component of reaching long-term recovery. Learning to modify behaviors and work through decision-making that has been altered by addiction can take time and can involve several bumps in the road. It can be difficult for pregnant women to focus their attention solely on recovery as they prepare for a newborn. There are special classes and forums they can attend that combine both subjects into a more integrative experience. Pregnant people should expect to continue their MAT after they’ve delivered their babies. This is especially important for those who may require pain management or are at higher risk of relapse.
Neonatal Abstinence Syndrome (NAS) is a broad term used to describe a group of conditions. It is caused when a baby withdraws from an addictive substance it was exposed to in the womb. NAS babies are predictably fussy and difficult to soothe, requiring extra care and attention upon birth. NAS can lead to long-term health and developmental issues including hearing and vision problems, as well as learning and behavioral disabilities.
Signs of NAS may include:
Neonatal Opioid Withdrawal Syndrome (NOWS) is a subcategory of NAS, focusing more on the effects of opioids on the newborn. When severe signs of NOWS appear, newborns may require doses of medication to help withdrawal symptoms if they don’t dissipate within several hours of birth. Thankfully, a study shows that babies from mothers who took buprenorphine during pregnancy are at a much lower risk of NOWS.
Studies show that buprenorphine and naloxone are safe to use while breastfeeding. This is overwhelmingly good news for new mothers. Sobriety can be challenging to balance with a newborn and interrupted sleep for a span of several months. Buprenorphine was shown to only appear at low levels in breast milk, blood, and urine of breastfed infants. Because naloxone has no oral bioavailability, only negligible amounts enter the bloodstream, and it’s unlikely to affect an infant in any way.
As with any medication, buprenorphine and naloxone can have some side effects on pregnant women that should be mentioned. The most common and mild effects include headaches, numbness or pain in the mouth, nausea and vomiting, drowsiness, insomnia, constipation, stomach and back pain, sweating, chills and increased heart rate. These effects tend to dissipate as the patient adjusts to their dosage over time.
Some adverse effects that require immediate medical attention include hallucinations, fainting or dizziness, confusion, unusual bleeding or bruising, liver damage or severe allergic reaction.
Long-term users may have some potential side effects such as depression, anxiety, night sweats, fatigue, restlessness and loss of libido. These can often be remedied with the help of a medical provider with additional medication or investigation of comorbidities that may be causing these conditions.
Doctors recommend that patients taking buprenorphine and naloxone during pregnancy continue their dosing schedule as advised. Abruptly stopping the use of the medication can cause acute withdrawal symptoms that can present dangers to the unborn baby. Symptoms can include but are not limited to preterm labor, fetal distress, and miscarriage. If a patient wants to taper their dosage, that should be discussed and planned with their medical provider to avoid any complications both during pregnancy and postpartum.
Pregnant women who struggle with opioid use disorder don’t have to give up their dreams of becoming mothers. Medication-assisted treatment programs at Middlesex Recovery include comprehensive methods that take care of patients through pregnancy and postpartum in collaboration with obstetricians and nursing staff. Motherhood is a life-changing occasion, and so is recovery; they can happen together with the help of buprenorphine and naloxone. To learn more about how Middlesex Recovery can help, message or call and speak to a representative today.
