Medication-Assisted Therapy (MAT) During Pregnancy: A Safe Treatment Option for Opioid Use Disorder

Written By SACCounty Healthy Beginnings

Medication-assisted therapy (MAT) is widely recognized as an effective treatment for substance use disorders (SUDs), particularly opioid use disorder (OUD). The American College of Obstetricians and Gynecologists recommends medication-assisted treatment over supervised withdrawal, as MAT can play a critical role in improving maternal and fetal outcomes. This blog examines MAT's safety, efficacy, and importance during pregnancy, exploring its benefits and addressing common concerns.

Understanding Medication-Assisted Therapy (MAT)

MAT programs combine FDA-approved medication with counseling and behavioral therapies to provide a whole-person approach and are a cornerstone of opioid use disorder treatment. Medications such as buprenorphine, naltrexone, and methadone help manage withdrawal symptoms and reduce cravings, providing a more stable pathway to recovery. MAT aims to stabilize the individual, minimize harm, and create an environment conducive to recovery.

The Importance of MAT During Pregnancy

Substance use during pregnancy poses significant risks to both the mother and fetus:

  • Preterm labor

  • Low birth weight

  • Neonatal abstinence syndrome (NAS)

  • Stillbirth

Neonatal Abstinence Syndrome (NAS) is a withdrawal condition that occurs in newborns exposed to opioids in the womb. Babies who experience withdrawal from narcotics can suffer from symptoms such as irritability, high-pitched crying, jitteriness, sweating, vomiting, diarrhea, seizures, and respiratory distress. While MAT medications can contribute to NAS, the impact is typically less severe than the outcomes associated with untreated OUD. Importantly, NAS is treatable, and the benefits of MAT for the mother and baby outweigh the risks. 

For the pregnant individual, abruptly discontinuing opioid use can lead to severe withdrawal symptoms, increasing the risk of miscarriage and preterm delivery. MAT provides a safer alternative by managing withdrawal symptoms and reducing cravings, which can help pregnant women maintain stability and engage in prenatal care.

Safety of MAT During Pregnancy

Numerous studies have confirmed the safety of MAT medications that reduce the risks associated with untreated OUD, such as overdose, infectious diseases, and poor prenatal care. Methadone and buprenorphine are recommended for treating opioid use disorder during pregnancy:

Methadone is a full opioid agonist that has been used for MAT since 1972, serving as the gold standard for treating OUD in pregnant women for decades. It effectively stabilizes the pregnant individual, reduces illicit drug use, and improves pregnancy outcomes. However, methadone requires daily visits to specialized clinics, which can be challenging for some.

Buprenorphine is a partial opioid agonist that was approved by the FDA for addiction treatment in 2002 and has emerged as a safe and effective alternative to methadone. It is a partial opioid that alleviates withdrawal symptoms with a lower risk of misuse. Unlike methadone, buprenorphine’s effects only increase up to a certain point – referred to as a “ceiling effect.” The benefits of buprenorphine include a reduced risk of side effects, and infants exposed to buprenorphine in utero tend to have less severe NAS compared to those exposed to methadone. Additionally, buprenorphine can often be prescribed in outpatient settings, increasing accessibility. However, buprenorphine may not prove as effective for individuals who have severe opioid disorders.

Efficacy of MAT in Improving Outcomes

MAT has been shown to significantly improve outcomes for both pregnant individuals and babies:

  • Reduced risk of relapse: MAT helps stabilize the pregnant individual, reducing the risk of relapse and associated complications such as overdose or infections.

  • Improved prenatal care: People receiving MAT are more likely to engage in regular prenatal care, which leads to better maternal and fetal health.

  • Healthier birth outcomes: Studies demonstrate that MAT reduces the incidence of preterm birth, low birth weight, and neonatal complications compared to untreated OUD.

Barriers and Challenges

Unfortunately, barriers and challenges exist that impede progress. For instance, many pregnant individuals, particularly those of color, often face increased stigma, discrimination, and child welfare involvement if they are taking medications for OUD. Additionally, in rural areas, long wait times for entry into a limited number of OUD treatment programs can reduce access, affect treatment rates, and ultimately lead to poorer short and long-term outcomes. 

In some instances, pregnant individuals may decide not to choose MAT. In these cases, The American College of Obstetricians and Gynecologists recognizes medically supervised withdrawal as a potential option under the care of an experienced healthcare provider.

Sacramento County is taking proactive steps to reduce barriers and provide more opportunities for treatment. Expanding telehealth services and integrating MAT into primary care settings while raising awareness about stigma, substance use, and mental health will continue to produce positive outcomes.

The Importance of Complementary Support Services

MAT is most effective when part of a comprehensive approach that includes behavioral health counseling and support. A history of trauma – most often sexual abuse – is the leading factor cited by pregnant people for the initiation of drug use. Holistic care that includes individual counseling, group therapy, prenatal care integration, and peer support programs can dramatically improve outcomes for pregnant people and infants.

Postpartum Considerations

Recovery does not end with childbirth. Postpartum care is vital to ensure postpartum stability and the baby’s well-being. Key considerations include:

  • Breastfeeding: Women on MAT are generally encouraged to breastfeed unless contraindicated by other factors (e.g., HIV infection). Breastfeeding provides benefits such as decreased severity of NAS, shorter hospital stays, and improved parent-child attachment. 

  • Continued MAT: Abrupt discontinuation of MAT post-delivery can lead to relapse; a gradual, monitored tapering process is recommended.

Pregnancy is often a time when individuals engage in healthcare services for the first time or reengage after a lengthy period of time. This engagement is an opportunity for healthcare professionals to provide care and support to improve outcomes both prenatally and postnatally. Linking individuals to parenting classes and behavioral health resources can help new parents build confidence and resilience and improve their overall health and that of their children. Discussing contraceptive options is important as well since the unintended pregnancy rate among women suffering from opioid disorders is much higher than in the general population.

Conclusion

 
 

MAT is a lifesaving intervention for pregnant women with opioid use disorder. By stabilizing the mother, reducing risks to the fetus, and promoting healthier outcomes, MAT is fundamental to comprehensive care. However, a gap exists between the level of treatment needed and the services provided. As healthcare systems, policymakers, and communities work together to expand access and reduce barriers, more pregnant people and their babies will have the opportunity to thrive.

 

Learn more about medication-assisted treatment in Sacramento County

 
SACCounty Healthy Beginnings
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