Buprenorphine Treatment for Opioid Use Disorder during pregnancy benefits mother and child: JAMA

Opioid use disorder during pregnancy has become far more common throughout the United States over the last decade, posing substantial risks to both mother and newborn. Although buprenorphine is a valuable medication to treat OUD and may have benefits for pregnancy outcomes, it is not administered in a large percentage of pregnant patients. Past studies have been restricted in examining the effect of buprenorphine versus no treatment in the real world, particularly on maternal and child health outcomes. Filling this void, this study provides rich evidence on how treatment access can alter health pathways for mothers as well as their infants.

This retrospective cohort study assessed 14,463 maternal-infant dyads with continuous enrollment in the Tennessee Medicaid program from 20 weeks' gestational age to 6 weeks postpartum during 2010-2021. Birth and death certificates were linked to Medicaid administrative claims for extensive data analysis, which was performed between April and October 2024. The exposure of interest was buprenorphine use during pregnancy, and the primary outcomes evaluated were adverse pregnancy events like preterm birth, NICU admission, infant death, severe maternal morbidity, intensive care unit (ICU) admission, and maternal death. Statistical analyses included logistic regression and propensity score approaches with overlap weighting to control for confounding variables.

Results

• 7469 women (51.6%) of the cohort received buprenorphine treatment during pregnancy, with a median maternal age of 27 years (interquartile range: 24–31 years).

Buprenorphine-treated dyads had a statistically significant decrease in adverse outcomes compared with untreated dyads (25.4% vs 30.8%; P <.001). In particular, buprenorphine use was linked to:

• A 5.4% severe maternal morbidity rate versus 6.9% in the untreated group (P <.001).

• A 14.1% preterm birth rate versus 20.0% in the untreated group (P <.001).

• A 15.2% NICU admission rate versus 17.2% in untreated individuals (P =.001).

Adjusted analyses supported these results, indicating that buprenorphine treatment resulted in:

• A 5.1 percentage point (pp) reduced chance of any unfavorable outcome (95% CI, 3.5-6.7 pp).

• A 1.2 pp reduced chance of severe maternal morbidity (95% CI, 0.4-2.1 pp).

• A 1.7 pp reduced chance of NICU admission (95% CI, 0.4-2.9 pp).

• A 5.3 pp reduced chance of preterm birth (95% CI, 4.0-6.6 pp).

• The number needed to treat (NNT) to prevent one adverse pregnancy outcome was 20, emphasizing the robust protective effect of buprenorphine treatment during pregnancy.

This large cohort study showed that pregnancy treatment with buprenorphine is linked with significantly improved maternal and infant outcomes. These results strongly support efforts to increase access to buprenorphine and incorporate substance use disorder treatment into routine prenatal care. Enhancing access to buprenorphine might be an essential step toward reducing the increasing weight of opioid-associated adverse outcomes for pregnant women and their newborns.

Reference:

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