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  • Barbara Hoefener NP

Suboxone (Buprenorphine) and Pregnancy

Updated: Aug 8, 2021

Written by Barbara Hoefener, FNP 3/2021

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Suboxone and Pregnancy - Notes from my training with Reference to the Mothers Study.

Pregnancy and Buprenorphine (Category C) “Mothers Study”

-Buprenorphine (& methadone) have been shown to be safe and effective in pregnancy & compatible with breastfeeding.

-Opioid maintenance therapy is recommended over detoxification.

-Buprenorphine diminishes the severity of NAS compared to methadone.

Maternal Benefits:

-70% reduction in overdose related deaths

-Decreased risk of HIV, Hepatitis B and Hepatitis C

-Increased engagement in prenatal care & recovery treatment

Fetal Benefits

-Reduces fluctuations in maternal opioid levels, thus reducing fetal stress (vs detoxification, then relapse in 78-98%. This increases fetal stress, and results in a 500% increase in the rate of still births)

-Decrease in intrauterine fetal demise

-Decrease in intrauterine growth restriction

-Decrease in preterm delivery

-Shorter NAS treatment duration in hospital and lower morphine dose if needed.

Dosing: Goal is to reach the dose just high enough to stop use and block cravings.

-Split dosing is ideal to meet the accelerated metabolic clearance of pregnancy

-Blood volume inc 45%, cardiac output inc 30-50%, GFR doubles, Drug clearance inc, and half-life dec w lower trough levels àcan lead to withdrawal symptoms à May need increase in medication. Women should report any withdrawal symptoms without fear an increase in meds will affect baby’s hospital stay or NAS treatment.

**There is NO correlation between maternal opioid maintenance therapy dose and duration or severity of NAS.**

Labor and Delivery: Labor pain is treated with Epidural only. Continue with maintenance dose without rapid taper.

Neonatal Abstinence Syndrome (NAS)= Generalized dysfunction of the autonomic NS, GI tract, and respiratory system.

-Occurs in 60-80% infants with intrauterine exposure to opioids/ maintenance therapy.

-Onset/ duration: Most infants present within 72 hours after delivery and can last up to 4 weeks. (longer >drugs)

-Treatment: Pharm: DTO, morphine, methadone.

*Non-Pharm*: Breastfeeding, skin to skin, swaddling, low stimulation environment, maternal room-in.

Breastfeeding Benefits for ALL:

-Benefits for all mother- infant pairs

-Decrease risk of SIDS, diabetes, and obesity for children

-Decreases risk of breast and ovarian cancer for women

-Improved infant cognitive development

-Improved mother-infant bonding

-Financial benefits (cost of formula isn’t cheap)

-Additional benefits for preterm infants

-50% reduction in necrotizing enterocolitis

-Better feeding tolerance and attainment of full enteral feedings

-Decreased rates of late onset sepsis.

-Improved developmental outcomes.

-Opioid use disorder/ NAS -- recommend Breastfeeding (Category L3)

-Buprenorphine has poor oral bioavailability, the amount in human breast milk is minimal.

-30% decrease development of NAS with 50% decrease in neonatal hospital stay

-Positive reinforcement for maternal recovery.

-Recommended for women with hepatitis, unless cracked or bleeding nipples. Pump/ dump until healed.

Contraindications to Breastfeeding.

-Maternal HIV infection

-Current Maternal substance use

-Recent heavy marijuana use because marijuana is lipophilic and concentrates in breast milk.

-If Bleeding, infected or cracked nipples (pump and dump until healed)- especially if hepatitis positive.

Reference: ASAM Buprenorphine Course 2019



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