Nirvana Recovery

Addressing Misconceptions and Stigma Around Pregnancy and Opioid Use Disorder

Addressing Misconceptions and Stigma Around Pregnancy

Opioid use disorder (OUD) is a growing concern in Arizona and across the United States, including among pregnant women. According to the CDC, Nationally, the prevalence of opioid use disorder more than quadrupled during 1999–2014 (from 1.5 per 1,000 delivery hospitalizations to 6.5; p<0.05). Increasing trends over time were observed in all 28 states with available data (p<0.05). Arizona observed a 41% increase of NAS cases from 592 (2017) to 835 (2021), as per the Arizona Department of Health Services. Despite the increasing prevalence, pregnant women with OUD often face significant stigma and barriers to seeking treatment. Many misconceptions persist about OUD in pregnancy and the recommended treatments. This article aims to address some of those misconceptions and present evidence-based information to encourage more women to seek the care they need.

Medication-Assisted Treatment (MAT) is the Standard of Care

Misconception: Pregnant Women Should Detox from All Opioids

  • One common misconception is that pregnant women with OUD should stop all opioid use immediately, and that continuing to take any opioids will harm the baby.
  • In reality, abruptly stopping opioid use can be dangerous for both the mother and fetus when physical dependence is present.
  • Withdrawal symptoms can lead to preterm labor, fetal distress, and miscarriage.
  • Relapse rates with medically supervised withdrawal alone are as high as 59-90%.

Fact: MAT is Recommended for Pregnant Women with OUD

Major medical organizations including the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine recommend medication-assisted treatment (MAT) with methadone or buprenorphine as the standard of care for pregnant women with OUD. These medications are opioid agonists that can:

  • Prevent erratic maternal opioid levels and protect the fetus from repeated withdrawal.
  • Reduce illicit opioid use and associated risks like infectious disease and overdose.
  • Increase engagement in prenatal care and addiction treatment.
  • Improve neonatal outcomes compared to no treatment or medically supervised withdrawal.

MAT During Pregnancy is Safe and Effective

Misconception

  • Methadone and Buprenorphine cause birth defects another common misconception is that the medications used in MAT are harmful to fetal development.
  • Some women may believe taking methadone or buprenorphine poses a higher risk of birth defects than continued illicit opioid use.

Fact: Decades of Research Shows No Increased Risk of Birth Defects with MAT

  • Methadone and buprenorphine have been used to treat pregnant women with OUD for over 40 years, and a large body of research has found no significant increase in birth defects with their use compared to the general population (SAMHSA).
  • More recent studies have shown buprenorphine is also a safe option, with no significant differences in congenital malformations compared to methadone or non-opioid exposed pregnancies.
The risks of untreated OUD in pregnancy are far greater. Healthcare professionals should reassure patients that MAT gives them the best chance for a healthy pregnancy and baby.

Severity of NAS is Not Related to Maternal MAT Dose

Misconception

  • Lowering the Methadone/Buprenorphine Dose Reduces NAS Neonatal abstinence syndrome (NAS) is a major concern for pregnant women with OUD.
  • It’s commonly thought that lowering the methadone or buprenorphine dose will reduce the chance or severity of NAS. Some women may try to minimize their dose for this reason.

Fact: No Correlation Found Between MAT Dose and NAS Severity

MOTHER NAS Scale

However, multiple studies have found no clear link between maternal methadone or buprenorphine dose and the incidence or severity of NAS. Key data:

  • In the MOTHER study of methadone vs. buprenorphine for OUD in pregnancy, the medication dose was not related to any NAS outcomes including peak score, total morphine needed for NAS treatment, duration of NAS treatment, or neonatal hospital stay.
  • A 2013 study by Lund et al. found median maternal buprenorphine dose of 13.3 mg in infants with NAS vs 14.1 mg in infants without NAS (p=0.51).
  • Cleary et al.’s 2010 meta-analysis concluded “the severity of NAS does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy.”

Rather than focusing on keeping the MAT dose low, clinicians should prioritize adequate dosing to control maternal withdrawal and cravings that could lead to relapse or treatment dropout. As pregnancy progresses, most women need dose increases to account for changes in medication metabolism and blood volume. This is key to maintaining maternal stability and giving the fetus the best environment to develop in.

While distressing for families, NAS is an expected and treatable outcome of necessary maternal treatment. Inform patients that the chances of NAS are similar with methadone and buprenorphine and that most babies with NAS recover with no long-term developmental effects. The benefits of MAT far outweigh the risks of NAS.

Stigma Remains a Major Barrier for Pregnant Women Seeking Treatment

Despite the strong evidence for MAT in pregnancy, stigma and misconceptions still discourage many women from seeking care.

In addition to stigma, barriers to engaging pregnant women in treatment include:

  • Lack of access to gender-specific programs that provide child care, transportation, and mental health services.
  • Fear of criminal or child welfare consequences.
  • Lack of coordination between OB and addiction treatment providers.
  • Feelings of shame, guilt and unworthiness.

Pregnant women with OUD may be fearful of the legal consequences they may face if they seek SUD treatment. Policies on whether and when to assume custody of a newborn or older child whose mother has untreated OUD vary by state, county, and even hospital. Healthcare professionals and office staff need to be aware of the regulations in their region.

Reducing Stigma and Improving Access to Care

Healthcare professionals can help reduce stigma and make it easier for pregnant patients with OUD to access treatment:

  • Educate colleagues and staff on the evidence base for MAT in pregnancy and the importance of a nonjudgmental approach.
  • Provide information on the benefits vs. risks of MAT and what to expect during pregnancy/postpartum.
  • Coordinate care between OB, pediatrics, and addiction treatment providers; consider integrated models.
  • Connect patients to support services like peer recovery groups, case management, housing and legal assistance.
  • Advocate for policies that reduce barriers and protect pregnant women who seek treatment.

Conclusion

Opioid use disorder is a life-threatening but treatable medical condition – and pregnancy provides a critical opportunity to help women enter recovery. With medication-assisted treatment and a comprehensive approach to prenatal and postpartum care, women can achieve healthy outcomes for themselves and their babies.

If you are pregnant and struggling with opioid use, please know you’re not alone and it’s never too late to reach out for judgment-free help. Contact Nirvana Recovery Center. Recovery is possible, and your and your baby’s health and wellbeing are worth it.

Furthermore, if you want to delve deeper into the factsheets, check out the PDF we’ve attached below. It has all the necessary details so you don’t miss any information. 

author avatar
Nirvana Recovery