Key takeaways:
Opioid-related diagnoses during pregnancy are associated with significantly higher maternal and neonatal morbidity.
Rates of opioid-related diagnoses among pregnant patients more than doubled in the United States over the past decade.
Pregnant patients with opioid-related conditions face increased risks of severe maternal morbidity and hypertensive disease.
Infants exposed to opioid-related diagnoses have higher risks of preterm birth, NICU admission, and neonatal abstinence syndrome.
Findings highlight the need for timely, multidisciplinary care and evidence-based treatment for opioid use disorder during pregnancy.
Maternal and infant infection are significantly more likely in patients with opioid-related diagnoses during pregnancy, according to a recent study published in the Journal of Addiction Medicine.1
Most prior data was obtained from international studies despite a significant and increasing use of opioids in the United States. This has made the new trial one of the largest population-based studies assessing both maternal and infant health outcomes linked to an opioid-related diagnosis within the past 10 years.1
“Given the prevalence and seriousness of this issue, we were surprised to see the lack of large-scale studies available,” said Jamie Lo, MD, MCR, lead study author and associate professor of obstetrics and gynecology in the OHSU School of Medicine.1
Rising prevalence of opioid-related diagnoses in pregnancy
The retrospective cohort study was conducted to evaluate the impact of opioid-related diagnoses in pregnancy on maternal and neonatal outcomes in a large, diverse population.2 Data from 2008 to 2020 was obtained from hospital discharge-vital statistics in California.
Singleton pregnancies with a gestational age of 23 to 42 weeks were eligible for inclusion, with hospital discharge data assessed for opioid-related diagnosis, maternal morbidity, and neonatal outcomes. Statistical analyses were performed using multivariable Poisson regression models.2
There were 5,546,744 pregnancies included in the final analysis, 0.25% of which had an opioid-related diagnosis. An increase in opioid diagnosis rates was observed during the study period, from 0.14% in 2008 to 0.33% in 2020.2
Increased morbidity associated with opioid use
Factors more common in patients with an opioid-related condition included hypertensive disease and severe maternal morbidity (SMM), with adjusted risk ratios (aRRs) of 1.23 and 1.84, respectively. For nontransfusion SMM, the aRR was 2.16, vs 1.77 for blood transfusion.2
Neonatal risks were also increased from opioid-related diagnoses. These included infant death, preterm birth under 87 weeks, neonatal intensive care unit admission, respiratory distress syndrome, and neonatal abstinence syndrome, with aRRs of 1.72, 1.71, 2.80, 2.40, and 70.18, respectively.2
Overall, the results indicated an over 2-fold increase in opioid-related diagnoses among pregnant patients in the past decade. Additionally, significant increases in maternal and neonatal morbidity have been reported among individuals with opioid-related diagnoses.2
“As providers, our goal is to support patients in a healthy pregnancy and transition to parenthood,” said Lo.1 “These data show that for those struggling with addiction, this should include timely, personalized multi-disciplinary care outside of standard prenatal checkups.”
Buprenorphine highlighted as a treatment option
To reduce these risks in pregnant patients, Baher Mankabady, MD, Senior Vice President at Indivior, highlighted the safety and efficacy of buprenorphine (SUBLOCADE; Indivior Inc) for treating opioid use disorder (OUD) in pregnancy.3 According to Mankabady, buprenorphine is a partial opioid agonist with a 20-year safety profile.
In 2025, Mankabady conducted a study with results confirming that buprenorphine, alongside showing safety and efficacy, improves adherence. Additionally, the treatment reduces rediversion, misuse, and abuse among patients. This provides nearly 5 years of data supporting the use of buprenorphine against OUD in pregnant patients.
“When patients with OUD, when they get pregnant, this is the time that they will be open for treatment and engagement with health care providers,” said Mankabady. “This study offers promising evidence that SUBLOCADE can be safely considered during treatment of OUD during pregnancy.”
