Methadone and Pregnancy: Can You Take Methadone While Pregnant?

Author: Samantha Kilbourne

Methadone is a full opioid agonist medication prescribed to manage severe opioid withdrawal symptoms. For pregnant parents who have an opioid use disorder (OUD), the question often arises: Can you take methadone while pregnant? Briefly, yes, methadone and pregnancy are compatible. No increased congenital disabilities or long-term neurodevelopmental impacts have been linked definitively with pharmacotherapy for OUDs.¹ However, while methadone is safer for unborn children and the gestational parent than opioid withdrawal or continuing opioid misuse, some concerns remain unaddressed. Medical professionals continue to emphasize that pregnant people should be informed about possible methadone and pregnancy risks.^{1, 2}

In this article:

• What is Methadone?
• Is it Safe to Take Methadone During Pregnancy?
• How Methadone and Pregnancy Affects Newborns
• Methadone and Breastfeeding
• Long-Term Effects of Methadone and Pregnancy on Babies
• Find a Methadone Treatment Center

What is Methadone?

Methadone is a long-acting, synthetic opioid and a Schedule II controlled medication-assisted treatment (MAT) used to treat opioid misuse since 1947.^{2, 3, 4} As such, it is classified as an opioid agonist. This activates receptors to elicit a biological response, satisfying neurological cravings for dangerous opioids, such as heroin and illicit fentanyl. It also prohibits euphoric effects associated with those opioids.² When medical professionals treat your opioid-specific substance use disorder (SUD) with methadone and pregnancy is unavoidable, it decreases withdrawal symptoms that are dangerous during pregnancy.

Is it Safe to Take Methadone During Pregnancy?

Research over the last four decades has been consistent. As a worldwide standard of care, methadone is a safe treatment for pregnant parents who have OUDs.^{2, 5} For example, if you use heroin and receive methadone pharmacotherapy during pregnancy, it reduces fetal exposure to heroin toxins. You also do not undergo unpredictable, rapid withdrawal and high cycles that can harm a fetus.⁵ Compared to untreated heroin dependence, methadone pharmacotherapy produces superior outcomes, such as:^{5, 6}

• Improved fetal growth
• Increased likelihood of obstetrical care
• Decreased risk of fetal HIV infection
• Lesser mortality rate
• Diminished risk of preeclampsia
• Fewer chances of relapse
• Reduced chances of criminality

Additionally, methadone can provide a stable intrauterine environment by stopping intravenous opioid use. This decreases the likelihood of infection, helps you control cravings and withdrawal, and helps you regain control of your life by engaging in daily activities and re-establishing social supports.^{1, 2}

Furthermore, comprehensive methadone maintenance programs will provide essential prenatal care as part of their services. Many pregnant parents with OUDs may go without these services otherwise.⁶

Nevertheless, the predominant controversy surrounding treatment with methadone and pregnancy is centered on two things: 1) optimal dosing and 2) associations with neonatal abstinence syndrome (NAS).⁶

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How Methadone and Pregnancy Affects Newborns

Many parents choose to stop methadone treatment before becoming pregnant. However, methadone is eliminated from different bodies at different rates. It can take two weeks for healthy, non-pregnant adult bodies to metabolize methadone.

Some studies recommend continuing or increasing the dosage to maintain pre-pregnancy physiological equilibrium.⁷ This rationale is considered  feasible because the pharmacokinetics of the methadone and pregnancy alters them accordingly, such as absorption rate, overall distribution, metabolism, and elimination.⁷

With use of methadone and pregnancy, during the last 3 to 4 weeks, the infant may undergo neonatal abstinence syndrome (NAS) (i.e., withdrawal), which can include the following symptoms:^{8, 10}

• Difficulty breathing
• Extreme sleepiness
• Irritability
• Poor feeding
• Tremors
• Sweating
• Diarrhea
• Vomiting
• Difficulty feeding
• Jitteriness
• Frequent crying that may be high pitched
• Vigorously sucking on a pacifier
• Fever
• Stuffy nose
• Seizures
• Stiff arms, back, and legs
• Fast breathing
• Trouble sleeping
• Frequent yawning and sleeping

How is Neonatal Abstinence Syndrome Treated on an Acute Basis?

Infants with NAS generally need to be treated in the NICU because of the severity of symptoms or comorbidities. Although the NICU environment can be overstimulating for infants with NAS, rooming-in is currently preferred because it promotes breastfeeding, skin-to-skin, and enhances the parent-infant relationship.¹⁰

In conjunction with the above, there are three ways in which NAS is treated: non-pharmacological, alternative, and pharmacological.¹⁰

• Non-pharmacological: This individualized approach is typically how treatment begins to maintain the parent-infant dyad and orient the infant while supporting the brain development. Specifically, these interventions may include:
  • Changes to the physical environment (decreasing visual and auditory stimuli by darkening and quietening the room)
  • Techniques associated with movement and touch (vertical rocking, C-position, side-lying, containment with hands held, swaying, swaddling, skin-to-skin time)
  • Pacifiers used to decrease oral hypersensitivity
  • Frequent, calorie-dense, on-demand, small volume, feeding
• Alternative: Ongoing studies are evaluating the effects of alternative interventions, but for now, massage therapy, foot, and auricular acupressure therapy, and Reiki have been shown to change the baby’s vitals positively and create a soothing effect.
• Pharmacological: It has been indicated that 27-91% of infants with NAS require this type of intervention, which can be associated with longer stays in the hospital for both parent and infant. Studies have attempted to find the optimal medication in such a circumstance, but results vary. However, opioids remain the preferred treatment for NAS. Dosing is contingent on the severity of the NAS symptoms.

Methadone and Breastfeeding

Unless there is a medication that would contraindicate treatment or you actively use many substances, breastfeeding is generally strongly encouraged.⁹ If you are being treated with methadone and pregnancy is ongoing or you are breastfeeding, the procedure is safe.⁴ It varies by person and by dosage; however, small amounts of methadone do get into the breast milk. Generally, taking up to 100 mg of methadone daily will be a nonissue for full-term, healthy infants pre-exposed to methadone during pregnancy.⁸ Because of this pre-exposure condition, some infants may have shorter hospital stays, less need for NAS treatment, and a shorter overall need for treatment if they are breastfed versus not being breastfed.⁸ Other benefits of breastfeeding include:⁹

• Less severe symptoms for the infant
• Shorter hospital stays
• Shorter use of pharmacological treatments (decreased number of days)
• Not affecting the symptoms of NAS

Long-Term Effects of Methadone and Pregnancy on Babies

Some experts do not agree on whether intrauterine exposure to medically assisted treatments (MATs)—specifically buprenorphine, naloxone, or methadone—will result in prolonged developmental issues for the infant.¹

A recent study emphasizes that it is unclear if methadone and pregnancy has neurobiological effects. However, in this study, the subjects did have impaired physical growth and difficulty meeting sensorimotor milestones.¹² Reduced density in the motor cortex and disruption in motor neuron intrinsic properties and local circuit connectivity were associated with these behavioral changes.¹⁰

Another study found evidence demonstrating that children of parents who received MAT during their pregnancy, specifically methadone or buprenorphine, had negative long-term effects. The authors noted that there may be bias in sampling resulting from the MAT group having risk factors that the unexposed comparison group did not have. These negative effects included reduced:¹¹

• Cognitive functioning
• Psychomotor functioning
• Behavioral functioning
• Attentional and executive functioning
• Affected vision

Scientific evidence is unclear as to what negative consequences methadone and pregnancy can cause, if any. Nonetheless, it is reasonable to accept that these children are exposed to emotional, familial, and environmental instability due to substance use culture. This often contributes to developmental difficulties.

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Early Interventions for Babies Born with NAS

Early interventions for babies born with NAS also strongly focus on the parents and family. This helps families manage newborns with specific sets of symptoms and characteristics (e.g., increased risk of low birth rate, poor feeding, sleep difficulties, irritability, prematurity) that could make care challenging.¹¹ A model used in Massachusetts focuses on:¹³

• Hospital Transition and Referral: The hospital staff collaborates with the family while the gestational parent is still in the hospital to permit collaboration between parties and prepare for continuity of care. This may include in-hospital visits by an early intervention specialist to help begin building positive rapport and reinforce suggestions and techniques provided by hospital staff.
• Family Education: A family-centered approach is utilized and allows for the engagement of all caregivers who may hold primary roles in the life of the child. This approach is used by staff knowledgeable about substance use, treatment, culture, food and clothing needs, community resources, etc. This approach welcomes open conversations to remove the stigma around mental health issues such as post-partum depression so that preventative care strategies are embraced rather than declined.
• Strategies: A team approach also is utilized and includes the family. Additional services or referrals are given, short-term goals are set, and home visits are implemented. Interventions provided by hospital staff are reinforced; focus is placed on services based upon the priorities of the family.

Find a Methadone Treatment Center

Methadone and pregnancy generally are acceptable together, but it is still advised to discuss this with your doctor. Continuing your methadone treatment while pregnant relatively benefits the infant and has not been shown to cause significant neurodevelopment aberrations.

To speak to a specialist about substance use recovery services like methadone treatment for pregnant parents, please call 800-994-1867Who Answers? to get info on an appropriate center or clinic near you.

Resources

1. Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants.
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Methadone.
3. National Institute on Drug Abuse. (2021). Medications to Treat Opioid Use Disorder Research Report.
4. Psychiatric Research Institute. (2022). What is Methadone?
5. Jones, H. E., Jansson, L. M., O’Grady, K. E., & Kaltenbach, K. (2013). The Relationship Between Maternal Methadone Dose at Delivery and Neonatal Outcome: Methodological and Design Considerations
6. Seligman, N. S., Almario, C. V., Hayes, E. J., Dysart, K. C., Berghella, V., & Baxter, J. K. (2010). Relationship Between Maternal Methadone Dose at Delivery and Neonatal Abstinence Syndrome.
7. Shiu, J. R., & Ensom, H. H. (2012). Dosing and Monitoring of Methadone in Pregnancy: Literature Review. Canadian Journal of Hospital Pharmacy, 65(5), 380-386.
8. Jansson, L. M., & Patrick, S. W. (2019). Neonatal Abstinence Syndrome. Pediatric clinics of North America, 66(2), 353–367.
9. Ito, S. (2018). Opioids in Breastmilk: Pharmacokinetic Principles and Clinical Implications. Journal of Clinical Pharmacology, 58(S10), 151-163.
10. Anbalagan, S. & Mendez, M. D. (2021). Neonatal Abstinence Syndrome.
11. Grecco, G. G., Mork, B. E., Huang, J., Haggerty, D. L., Reeves, K. C., Gao, Y., Hoffman, H., Katner, S. N., Masters, A. R., Morris, C. W., Newell, E. A., Engleman, E. A., Baucum, A. J., Kim, J., Yamamoto, B. K., Allen, M. R., Wu, U., Lu, H., Sheets, P. L., & Atwood, B. K. (2021). Prenatal Methadone Exposure Disrupts Behavioral Development and Alters Motor Neuron Intrinsic Properties and Local Circuitry.
12. Andersen, J. M., Høiseth, G., & Nygaard, E. (2020). Prenatal Exposure to Methadone or Buprenorphine and Long-Term Outcomes: A Meta-Analysis. Early Human Developments, 143, 1-13.
13. Massachusetts Department of Public Health. (2017). Early Intervention Engagement for Families Impacted by Neonatal Abstinence Syndrome (NAS) and Substance Exposed Newborns (SEN): A Model of Support.