Opioid Misuse During Pregnancy: Potential Risks and Effects

What Are Opioids and How Do They Work?

Opioids are commonly prescribed as painkillers to help relieve acute, moderate to severe pain following surgery or injury. They work by binding to specific receptors in the brain and spinal cord to diminish the body’s perception of pain.¹ Common prescription opioids include:¹

• Hydrocodone.
• Oxycodone.
• Morphine.
• Codeine.

The use of prescription opioids is generally safe when they are taken as prescribed and only used for a short time.¹ However, opioids carry a high risk for misuse, which occurs when an individual:¹

• Takes opioids in a manner other than prescribed—such as taking a higher dose, taking it more frequently, or crushing the pills and dissolving them in water to inject them rather than swallow them.
• Takes another person’s prescription opioids.
• Takes opioids to get high.

Repeatedly misusing opioids can be extremely dangerous since they can be highly addictive and lead to an opioid use disorder, the clinical term for an opioid addiction (OUD), which is characterized by the compulsive drug seeking and use despite the harmful impact it has on all aspects of your life.¹

Women and Opioids

Some research indicates that women—more than men—may be more sensitive to pain and more likely to experience chronic pain, which may contribute to the high rates of opioid prescriptions among women, who are of reproductive age. Additionally, studies suggest that women may be more likely to take prescription opioids without a prescription to self-treat pain as well as anxiety or tension.²

Effects of Opioid Misuse During Pregnancy

It is recommended that pregnant women talk to their doctor about their opioid use and their options for OUD treatment. That’s because every situation and individual is different, and several things factor into the safety of opioid use and pregnancy.³

For instance, women who are pregnant and in treatment for OUD may be advised to continue to take prescribed medications for opioid addiction treatment to avoid withdrawal symptoms and relapse—both of which could be harmful to the baby. As a means of recovery, OUD treatment medications are commonly the safest option for both the mother and the baby.⁴

Without treatment, continued misuse of opioids during pregnancy can lead to negative outcomes for both mother and baby, including:^1,5

• Miscarriage.
• Preterm birth.
• Stillbirth.
• Poor fetal growth and development.
• Birth defects.
• Neonatal abstinence syndrome (NAS), which includes a cluster of manageable withdrawal symptoms in infants. Neonatal opioid withdrawal syndrome (NOWS) is a form of NAS that is specific to opioid use.
• Maternal death.

Is it Safe to Quit Opioids During Pregnancy?

Plans for opioid use disorder recovery during pregnancy can be made safely in collaboration with your doctor.⁶ Sudden cessation or reduction of opioid use can result in withdrawal symptoms that can cause stress on the baby and maternal drug cravings, which increase the likelihood of miscarriage and relapse.^7,8

As the preferred treatment intervention, pregnant women with an opioid use disorder may be prescribed opioid agonist pharmacotherapy—usually methadone or buprenorphine—as opposed to undergoing a medically supervised detox, which may be associated with high rates of relapse and worse outcomes.⁷ Healthcare providers may also modify elements of prenatal care to meet the clinical needs of the pregnant individual and the developing fetus. Thus, because every individual has their own unique needs; creating a plan with your doctor is the safest option during pregnancy.⁶

Data and Statistics

Some of the recent statistics surrounding pregnancy and the use of opioids include the following:^5,7

• In 2019, approximately 7% of pregnant women reported the use of opioid pain relievers during pregnancy. Of those, 20% of women reported misusing opioids.
• Studies have not found significant differences in cognitive development between children who were exposed to methadone—an opioid agonist that may be effectively used during OUD treatment—in utero and those who were not.
• Attempting withdrawal from opioids, even medically supervised withdrawal, during pregnancy, is associated with high relapse rates ranging anywhere from 59% to more than 90%. Relapse poses dangerous risks, including accidental overdose and death.

Treatment for Opioid Use Disorder During Pregnancy

If you or a loved one are pregnant and struggling with opioid misuse or addiction, treatment can help you and your baby. While getting help as early as possible can aid in minimizing health risks for you and your baby, it’s never too late. Seeking treatment during pregnancy can improve your therapeutic outcomes and, ultimately, your recovery outlook as a whole. Medication, combined with prenatal care and a comprehensive treatment program can improve the chances of having a healthier baby.¹

Treatment for opioid use disorder typically includes a combination of pharmacotherapy (opioid agonist medications such as methadone or buprenorphine) and behavioral therapies—all of which may take place in an inpatient setting, partial hospitalization program (PHP), intensive outpatient program (IOP), or in a standard outpatient setting.³

Federal law actually requires publicly funded substance use disorder treatment programs to grant pregnant women priority admission, allowing them to bypass wait lists and start treatment immediately. Additionally, some substance use rehab programs offer specialized treatment tracks for women who are pregnant, which may provide prenatal care, childcare, parenting classes, pregnancy education and counseling, life skills workshops, and job training and placement.⁹

Treatment for Infants Affected by Neonatal Opioid Withdrawal Syndrome (NOWS)

As previously mentioned NOWS is a form of NAS, which is a collection of physiological and neurobehavioral signs of withdrawal that can occur in newborns after long-term exposure to opioids while in utero.⁴ Symptoms tend to appear within the first 24 to 48 hours after birth. However, symptoms are sometimes slower to present and may not appear for 5 to 10 days after birth.¹⁰

A child born with NOWS or another form of NAS may exhibit symptoms that include:^5,10

• Irritability.
• Sleep disturbances.
• Frequent yawning.
• Stuffy nose.
• Hyperactive reflexes.
• Tremors.
• Difficulty feeding.
• Loose or watery stools.
• Dehydration.

The severity and length of NOWS depends on the gestational age of the baby—whether it was born prematurely or full term—the type of opioid used, and when it was last used.^5,10

It is important to note that a baby born with NAS or NOWS does not have an opioid addiction. Neonatal abstinence syndromes, including NOWS, are manageable—often with relatively conservative measures. Treatment for a newborn with NOWS may include:¹¹

• Keeping the infant in a dark, quiet area, minimizing both light and sound exposure, or allowing the baby to remain in the same room with the mother.
• Swaddling them.
• Gently rocking the baby.
• Providing frequent, small amounts of breast milk or high-calorie formula to help with feeding problems.
• Giving the baby withdrawal management medications if withdrawal symptoms are severe or slow to improve.

The most effective care of an infant with NOWS or another form of NAS also involves and supports the mother.¹¹

Postpartum Treatment and Support for Women with OUD

The postpartum period—the first few months after giving birth—sometimes referred to as the fourth trimester, can be a difficult time of increased vulnerabilities for any woman. For women with an opioid use disorder, the postpartum period can be compounded with the additional stressors related to addiction.¹² Women with opioid use disorder relapse far more often in the postpartum period compared with during pregnancy.⁷ And relapse may contribute to overdose, the leading cause of postpartum death.¹²

Additionally, pregnant and postpartum women with an opioid use disorder often suffer from co-occurring mental health conditions, such as depression, post-traumatic stress disorder (PTSD), and anxiety. In fact, one study found that 30% of pregnant women enrolled in a substance use treatment program were diagnosed with moderate to severe depression; 40% reported symptoms of postpartum depression.⁷

However, evidence-based integrated treatment—that simultaneously treats the opioid use and co-occurring mental health disorders—and incorporates medication for opioid addiction and behavioral interventions can help. Studies indicate that women who engage with treatment for opioid use disorder during pregnancy and continue postpartum have a decreased risk of overdose and an increased likelihood of healthy outcomes.¹² Furthermore, postpartum treatment should include access to adequate postpartum psychological support services, relapse prevention programs, and parenting classes.^7,12

You can ask your doctor for a referral to a rehab program that specialize in pregnant women with opioid use disorder. You can also call American Addiction Centers (AAC) at and speak to one of our compassionate and knowledgeable admissions navigators, who can help you find resources in your area where you can get the treatment and care you need for you and your baby.