Buprenorphine in pregnancy reduces adverse outcomes

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Maternal and infant outcomes are improved by buprenorphine treatment in pregnant women with opioid use disorder (OUD), according to a recent study published in JAMA Health Forum.¹

In 2017, 8.2 pregnant patients per 1000 delivery hospitalizations presented with OUD, increasing the risks of adverse outcomes such as overdose, infection, severe maternal morbidity (SMM), and death.² In 2002, the FDA approved buprenorphine for OUD treatment, leading to clinical trials comparing its efficacy with the prior standard treatment, methadone.¹

“In contrast, existing research comparing treatment to no treatment has been limited to analyses from methadone treatment in the 1970s,” wrote investigators.

Assessing buprenorphine outcomes

The population-based study was conducted to address this gap in research, comparing buprenorphine treatment in pregnancy to no treatment. Maternal-infant dyads in the Tennessee Medicaid program from 20 weeks’ gestation to 6 weeks postpartum were included in the analysis.

Additional eligibility criteria included being aged 15 to 44 years, diagnosed with OUD or with a buprenorphine prescription during pregnancy, and having a singleton fetus. Pregnant patients with methadone, naltrexone, or non-OUD buprenorphine prescriptions were excluded from the analysis.

Data was obtained by linking Medicaid administrative data to birth and death certificates. This allowed buprenorphine treatment between 20 weeks’ gestation and birth to be identified as the primary exposure.

Maternal and infant outcomes

SMM, intensive care unit (ICU) admission, and maternal death were reported as primary maternal outcomes, while primary infant outcomes included preterm birth, neonatal ICU (NICU) admission, and infant death. Gestational age, birth weight, and more than 6 hours of assisted ventilation were reported as secondary outcomes.

Covariates included race and ethnicity, age, marital status, education level, location of residence, parity, chronic medical conditions, prepregnancy body mass index, pregnancy-specific medical conditions, infection, prior cesarean delivery, delivery method, early prenatal care, and prenatal smoking. Maternal substance use disorders were also reported.

Study population characteristics

There were 14,463 maternal-infant dyads between 2010 and 2021 included in the analysis, 51.6% of whom received buprenorphine. Of this group, 1.1% were Hispanic, 2.1% non-Hispanic Black, 94.7% non-Hispanic White, and 2.1% another race.

In those with no treatment, these rates were 1.7%, 10.2%, 85.5%, and 2.6%, respectively. Similar demographics and pregnancy characteristics were reported between groups, and both groups had high rates of comorbid substance use.

Trends in adverse pregnancy outcomes

An increase in adverse pregnancy outcomes was reported among the study population, from 27% in 2010 to 31.6% in 2021. For maternal outcomes, the increase was from 4.9% to 5.6%, while infant outcomes rose from 24.5% to 29.7%.

Overall, the buprenorphine group presented with a statistically significant reduction in adverse pregnancy outcomes, at 25.4% vs 30.8% in the untreated group. In the buprenorphine group, rates of SMM, preterm birth, and NICU were 5.4%, 14.1%, and 15.2%, respectively.

In the untreated group, these rates were 6.9%, 20%, and 17.2%, respectively, indicating a higher risk. However, ICU admission, maternal death, and infant death rates did not differ between groups.

Risk reductions and conclusions

Overall, an odds ratio (OR) of 0.77 was reported for composite adverse pregnancy outcomes among patients with buprenorphine treatment vs no treatment. For SMM, the OR was 0.80.

The risk of preterm birth was also reduced, with an OR of 0.65. This data highlighted significant reductions in adverse pregnancy outcomes from buprenorphine treatment.

“In this cohort study of pregnant individuals with OUD, we found that buprenorphine use in pregnancy was associated with improvements in pregnancy and infant outcomes, underscoring the need for OUD treatment expansion,” wrote investigators.

References

1. Krishnapura SR, McNeer E, Loch SF, et al. Buprenorphine treatment in pregnancy and maternal-infant outcomes. JAMA Health Forum. 2025;6(4.11):e251814. doi:10.1001/jamahealthforum.2025.1814
2. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes.Anesthesiology. 2014;121(6):1158-1165. doi:10.1097/ALN.0000000000000472