Help is available. Our goal is to help mothers and their children throughout the recovery process.

What is Medication Assisted Treatment (MAT)?

MAT is the use of FDA approved medications to minimize withdrawal symptoms and decrease cravings for opioids, alcohol, or nicotine. There is not currently FDA approved MAT for stimulants or other substances. Generally this is medication that taken daily, though there are formulations that allow for once a month administration. MAT is associated with increased engagement in prenatal care, which is associated with better pregnancy outcomes. MAT also results in lower rates of infection such as HIV, Hepatitis B, and Hepatitis C which can have negative fetal outcomes.

Is MAT safe for baby?

For people with opioid use disorder, buprenorphine and methadone are recognized as safe in pregnancy. While neonatal abstinence syndrome and lower birth weights are possible, expected side effects of MAT use, discussion should be had with your physician regarding the benefits of MAT compared to the risks of continuing to use other opioids. Currently, information on the safety of naltrexone during pregnancy is limited. For individuals with alcohol use disorder and nicotine use disorder, MAT is prescribed on an individualized basis, based on a discussion with your physician regarding the risks and benefits. 

If I am on MAT already, will I need to change my MAT dose when I become pregnant?

For women with opioid use disorder, during pregnancy it is recommended that a woman be on the dose that helps her to not have cravings or use other opioids. For expected side effects like neonatal abstinence syndrome (NAS), there is no association between dose and risk. Meaning that women should not seek to decrease their dose if it is effective to decrease the risk of this happening. If a woman would like to come off of MAT during their pregnancy, this should be discussed with your physician to determine if this is a safe plan during pregnancy. For women who are on buprenorphine containing products, doses often do not need to be changed. For women on methadone, dose changes may be required as the pregnancy progresses. 

How long will I need to be on MAT?

There is good evidence that persons with opioid use disorder should be continued on MAT for as long as it helps the patient. Patients should not be required to discontinue according to preset timelines.  Evidence regarding the duration of treatment with MAT for alcohol use disorder, suggests persons be on these medications for up to a year, or at periods in which the person is high risk for returning to use. 

Will I be able to breast feed on MAT?

For opioid agonist treatment related MAT (buprenorphine and methadone) it is safe for women to initiate and continue breastfeeding while on the medication, as long as there are no other reasons she should not be breastfeeding. Women on naltrexone during or after pregnancy should be encouraged to breastfeed. 

What is Neonatal Abstinence Syndrome (NAS)?

Neonatal abstinence syndrome (NAS) is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth. Withdrawal caused by opioids, including medication-assisted treatments buprenorphine and methadone, is also called Neonatal Opioid Withdrawal Syndrome (NOWS). NOWS is an expected side effect that occurs in newborns 48-72 hours after birth. Research shows that women who are on either methadone or buprenorphine tend to have lower rates of NOWS than women who have been on other opioids. Symptoms of NOWS include:

• Tremors
• Irritability, high-pitched crying
• Sleep problems
• Hyperactive reflexes
• Yawning, stuffy nose, sneezing
• Poor feeding
• Vomiting
• Loose stools, dehydration
• Increased sweating
• Seizures

Research shows that there is no link between the dose of opioid that a mother is using during pregnancy and the severity of NAS/NOWS. For this reason it is recommended that while pregnant women remain on the most effective dose of medication-assisted treatment. Decreasing the dose during pregnancy does not result in lower rates of NAS or less severe NAS. Decreasing the dose can result in relapse to using other opioids that can cause other risks to the pregnancy. 

Is NAS dangerous to my baby?

While opioid withdrawal is not generally life threatening to adults, it can be dangerous to newborns due to the dehydration that it can cause, or the potential for seizures. NAS is different for each newborn, and there are few ways to predict which newborn will have it or how severe it will be if it occurs. For this reason your doctor will monitor the newborn for 48-72 hours after delivery for signs of NAS. If your baby has NAS your doctor and treatment team will treat the symptoms by keeping your newborn calm and comfortable. If the symptoms are severe your newborn may be transferred to the NICU or receive medication like morphine. Current research shows that if medications are used there are no long term harms to the newborns development. Medication-assisted treatment, like use of other opioids, can be associated with lower birth weights. 

Will my baby have to stay in the hospital?

Newborns should be monitored for 48-72 hours after delivery for symptoms of NAS. Many newborns have no evidence of NAS or mild forms of the condition, and can be followed by doctors outside of the hospital. Some newborns will experience moderate to severe NAS which will require that they stay in the hospital for days to weeks after delivery. The most severe forms of NAS will require that the newborn be placed on medication like morphine or methadone and monitored in the hospital. Some cases will require monitoring in the NICU.

Will I be able to breast feed?

Yes, women whose newborns are experiencing NAS will be able to breastfeed. Women who are on medication-assisted treatment are also encouraged to breastfeed. The only reason that a woman would not be allowed to breast feed would be if there were another condition present such as active HIV or active substance use.

For more information please review the following fact sheets:

• Treating Opioid Use Disorder
• Opioid Use Disorder and Pregnancy
• Good Care for You and Your Baby While Receiving Opioid Use Disorder Treatment
• Treating Babies Who Were Exposed to Opioids Before Birth