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.