Buprenorphine during pregnancy improves outcomes for mothers, babies

Key takeaways:

• Only half of pregnant women with opioid use disorder receive treatment in the United States.
• Buprenorphine reduced the probability of severe maternal morbidity, NICU admission and preterm birth.

HONOLULU — Buprenorphine treatment during pregnancy improved perinatal outcomes for women with opioid use disorder and their babies, compared with no treatment, according to a new study.

The number of pregnant women with opioid use disorder (OUD) has grown from 1.5 per 1,000 delivery hospitalizations in 1999 to 8.2 per 1,000 delivery hospitalizations in 2017, according to Sunaya R. Krishnapura, BA, a graduating medical student at Vanderbilt University School of Medicine, who presented findings from the study at PAS 2025. Further, she said pregnant women are less likely to receive an appointment with clinicians about OUD treatment than nonpregnant women.

“Existing research on buprenorphine use in pregnancy has focused on comparing its clinical outcomes with those of methadone,” Krishnapura told Healio. “However, there is limited research examining the impact of buprenorphine treatment vs. no treatment on outcomes for mothers and infants.”

She said it is important to study how buprenorphine treatment affects mothers and infants compared with no treatment because only half of pregnant women in the United States receive treatment for OUD.

Krishnapura and colleagues conducted a retrospective cohort study of 14,463 pregnant women (median age, 27 years; interquartile range, 24 to 31 years) enrolled in Tennessee’s Medicaid program who had been diagnosed with OUD between 2010 and 2021. Roughly half (n = 7,469) received buprenorphine treatment between 20 weeks’ gestational age and birth, whereas the remaining received no treatment. The researchers assessed perinatal outcomes occurring up to 6 weeks after delivery.

The study was also published in JAMA Health Forum.

Overall, women and infants in the treatment group experienced fewer adverse perinatal events compared with those who did not receive treatment (25.4% vs. 30.8%; P <.001).

The researchers noted that non-Hispanic Black women were significantly less likely to get treatment — 2% of women who did receive treatment were Black compared with 10% of those who did not (P < .001).

After adjusting for confounding factors, the researchers found that buprenorphine treatment reduced the probability of severe maternal morbidity by 1.2 (95% CI, 0.4-2.1) percentage points, NICU admissions by 1.7 (95% CI, 0.4-2.9) percentage points and preterm birth by 5.3 (95% CI, 4-6.6) percentage points. The probability of any adverse event was 5.1 (95% CI, 3.5-6.7) percentage points lower in the treatment group.

“We typically think of buprenorphine providing a significant benefit to pregnant women, and it does,” Krishnapura said. “However, we found that treating mothers with buprenorphine is also associated with a profound reduction in preterm birth.”

“These findings underscore the crucial need for treatment expansion in the United States,” she said.

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For more information:

Sunaya R. Krishnapura, BA, can be reached at sunaya.r.krishnapura@vanderbilt.edu and on Bluesky at @sunayak.bsky.social.