Opioid Treatment in Pregnancy

What did the study find about opioid treatment and newborn withdrawal?

The research, published October 29 in JAMA Network Open, examined pregnancies involving methadone or buprenorphine treatment. Researchers measured the medicines and their breakdown products in umbilical cord tissue, which reflects exposure during late pregnancy, and compared those measurements with neonatal opioid withdrawal syndrome, or NOWS. Higher measured concentrations were not associated with more severe withdrawal. [University of Maryland study announcement](https://www.medschool.umaryland.edu/news/2026/study-provides-reassuring-news-for-women-using-medications-to-treat-opioid-use-disorder-during-pregnancy.html).

This was an observational analysis, not a trial assigning patients to lower or higher doses. Participants had received treatment for at least 30 days before delivery and delivered at 34 weeks or later. The small sample and limited demographic diversity restrict how widely the results can be applied. An association that was not detected cannot be ruled out altogether, and the study does not establish safety across every pregnancy or childhood outcome. [JAMA Network Open research letter](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855947).

Should methadone or buprenorphine doses be reduced during pregnancy?

Methadone and buprenorphine help control withdrawal and cravings in people with opioid use disorder. If treatment is inadequate, symptoms can return and increase the likelihood of resuming nonprescribed opioid use. The American College of Obstetricians and Gynecologists identifies inadequate methadone dosing as a potential cause of withdrawal, fetal stress, cravings, and treatment discontinuation. [ACOG clinical guidance](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy).

CDC guidance recommends methadone or buprenorphine during pregnancy and favors medication treatment over withdrawal management through tapering. Pregnancy-related physiological changes can also require dose adjustments, particularly in the third trimester. Patients experiencing cravings, withdrawal, or troublesome adverse effects should contact their prescribing team for reassessment; they should not skip doses or change treatment independently. [CDC guidance on opioid use and pregnancy](https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-and-pregnancy.html).

What does the research mean for newborn care and medication choice?

The study found severe withdrawal more frequently among methadone-exposed newborns than among those exposed to buprenorphine. However, an observational comparison cannot establish which medicine is best for every patient or justify an automatic switch. Its central finding concerns dose and measured exposure: these did not reliably distinguish newborns with more severe withdrawal. [JAMA Network Open research letter](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855947).

CDC advises coordination between prenatal, addiction-treatment, and pediatric teams so that exposed newborns can be assessed and treated when needed. Withdrawal can occur despite appropriate maternal treatment; concern about it alone should not prevent access to medication. Care also needs to continue after birth: CDC recommends continuing prescribed treatment postpartum, with clinical monitoring and dose adjustments when appropriate. [CDC pregnancy and postpartum treatment guidance](https://www.cdc.gov/opioid-use-during-pregnancy/treatment/).