Pregnancy and Opioid Use Disorder

Pregnancy can be a powerful turning point, especially for women living with opioid use disorder. Many women feel scared, judged or unsure where to turn when they become pregnant while using opioids. Some worry about harming their baby or losing custody if they ask for help. The truth is that treatment during pregnancy is recommended and lifesaving. With the right care, women with opioid use disorder can have healthy pregnancies and healthy babies.

Opioid use disorder (OUD) is a medical condition that affects how the brain controls pain, stress and survival. Pregnancy does not make addiction disappear, and willpower alone is not enough to stop opioid dependence. Many pregnant women continue using opioids to avoid painful withdrawal and to function day to day.

OUD affects women of all ages, races and backgrounds. Being pregnant with OUD does not mean someone is a bad parent — it means they need medical care and support. Pregnancy can increase emotional stress, especially for women with OUD.  Many women fear judgment, child welfare involvement or losing their baby. These fears often stop women from seeking care.

Supportive treatment helps address:

  • Anxiety and depression
  • Trauma and past experiences
  • Parenting fears and questions
  • Safety and stability planning

When women feel supported, they are more likely to stay engaged in care.

When opioid use disorder is not treated, both mother and baby face higher health risks. Repeated cycles of intoxication and withdrawal can place stress on the body and uterus. Unstable use also increases the risk of overdose, especially with fentanyl. 

Possible risks of untreated OUD include:

  • Poor nutrition and dehydration
  • Infections or untreated medical conditions
  • High stress levels that affect fetal development
  • Preterm birth or low birth weight
  • Increased overdose risk during pregnancy or after delivery

Stable treatment reduces many of these risks. Importantly, babies born to mothers in stable treatment tend to:

  • Be born closer to full term
  • Have healthier birth weights
  • Require shorter hospital stays
  • Have better long-term outcomes

Treatment improves outcomes for both mother and baby. At Foundations Health OTPs, we provide pregnancy-informed, compassionate care, including:

  • Medications for opioid use disorder that are safe during pregnancy
  • Coordination with obstetric and prenatal providers
  • Counseling and behavioral health support
  • Education about pregnancy, birth and newborn care

Choosing treatment during pregnancy is an act of strength and care. It protects your health, supports your baby and lays the foundation for a healthier future. You deserve care without judgment.

If you are pregnant and using opioids, you are not alone — and help is available today. Starting treatment can help make pregnancy safer and support you through every stage. Our goal is to support both safety and dignity.

If you are pregnant and struggling with opioid use, contact a Foundations Health Opioid Treatment Program today. Our team can help you understand your options and provide supportive care. 

Frequently Asked Questions

The most important step is to seek medical care as soon as possible. You do not need to stop using opioids on your own. In fact, medical experts warn that sudden withdrawal during pregnancy can increase health risks (American College of Obstetricians and Gynecologists [ACOG], 2021). An Opioid Treatment Program (OTP) can help you stabilize safely with medication and connect you to prenatal care. Early treatment improves outcomes for both mother and baby (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023).

Medical guidelines do not recommend sudden detox during pregnancy because withdrawal may increase stress on the pregnancy and increase relapse risk (ACOG, 2021). Medication treatment is considered safer and more effective.

Stopping opioids suddenly during pregnancy can cause withdrawal, which may be harmful to the mother and her unborn child. Withdrawal places stress on the nervous system and can affect blood flow to the uterus. Withdrawal symptoms may include:

  • Severe nausea, vomiting and diarrhea
  • Shaking, sweating and chills
  • Anxiety, panic and restlessness
  • Dehydration and exhaustion
  • Increased risk of miscarriage or preterm labor

Medical experts at the American College of Obstetricians and Gynecologists (ACOG, 2021) recommend treatment with medication and connecting to prenatal care, not sudden detox. Medication for opioid use disorder (MOUD) is the safest and most effective treatment during pregnancy. Medications such as methadone and buprenorphine help stabilize the brain and prevent withdrawal. Medication treatment is the standard of care.

Yes. Medication for opioid use disorder (MOUD), such as methadone or buprenorphine, is the recommended standard of care during pregnancy (ACOG, 2021; SAMHSA, 2023). These medications reduce cravings, prevent withdrawal and lower overdose risk. Research shows that women in treatment have better pregnancy outcomes than women who continue unstable opioid use (National Institute on Drug Abuse [NIDA], 2023).

MOUD during pregnancy:

  • Reduces cravings and illicit opioid use
  • Lowers overdose risk
  • Supports consistent prenatal care
  • Improves pregnancy and birth outcomes

These medications are widely recommended by medical experts.

Untreated opioid use disorder increases health risks for both mother and baby. Repeated withdrawal and unstable opioid use can lead to poor prenatal care, infections, overdose risk, and stress on the pregnancy (ACOG, 2021).

Possible risks include:

  • Preterm birth
  • Low birth weight
  • Pregnancy complications
  • Increased maternal overdose risk

Stable treatment reduces many of these risks (SAMHSA, 2023).

Some babies exposed to opioids during pregnancy may develop neonatal opioid withdrawal syndrome (NOWS), sometimes called neonatal abstinence syndrome (NAS). This condition is temporary and treatable (NIDA, 2023). Medical teams monitor babies closely and provide supportive care when needed.

Babies born to mothers in stable treatment generally have better outcomes than babies exposed to unstable opioid use (ACOG, 2021).

No. Some babies exposed to opioids during pregnancy may experience neonatal opioid withdrawal syndrome (NOWS). NOWS is temporary and treatable. It is not the same as addiction. Addiction involves behaviors such as cravings and loss of control. Babies cannot experience addiction in that way. NOWS is a medical condition caused by opioid exposure before birth and is treatable (NIDA, 2023).

The period after delivery is a high-risk time for relapse and overdose. Changes in hormones, sleep, stress, and changes in the body’s sensitivity to opioids (tolerance) increase risk (SAMHSA, 2023). Continuing treatment after delivery:

  • Protects the mother’s health
  • Reduces overdose risk
  • Supports bonding and parenting
  • Helps maintain long-term recovery
  • Ongoing care matters just as much as prenatal care

Continuing treatment after birth can protect maternal health and support parenting and recovery.

In many cases, yes. Women who are stable in treatment and not using illicit substances are often encouraged to breastfeed. Breastfeeding may even reduce the severity of neonatal withdrawal symptoms (ACOG, 2021). Your healthcare provider can guide you based on your individual situation.

Policies vary by state. However, seeking treatment is considered a protective and responsible action. Medical organizations strongly support treatment engagement during pregnancy (ACOG, 2021). Treatment participation often demonstrates commitment to health and safety.

Foundations Health OTPs provide:

  • Evidence-based medications for opioid use disorder (SAMHSA, 2023)
  • Coordination with prenatal care providers
  • Mental health counseling
  • Overdose education and naloxone training
  • Continued support after delivery

References

American College of Obstetricians and Gynecologists. (2021). Opioid use and opioid use disorder in pregnancy. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy 

National Institute on Drug Abuse. (2023). Substance use while pregnant and breastfeeding.
https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding 

Substance Abuse and Mental Health Services Administration. (2023). Medications for opioid use disorder (Treatment Improvement Protocol 63). https://library.samhsa.gov/product/tip-63-medications-opioid-use-disorder/pep21-02-01-002 

Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States. https://www.samhsa.gov/data

LEARN MORE

Treatment

Contact Foundations Health Today