On average, a baby is born in withdrawal from opioids every 15 minutes in the U.S., according to recent research.
Opioid use during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome or neonatal opioid withdrawal syndrome (NAS/ NOWS). About 50 to 80 percent of opioid-exposed infants require medication to manage their withdrawal symptoms, which typically manifest a few days after birth. These include irritability, difficulty soothing, trouble eating and sleeping, and diarrhea.
Naltrexone, buprenorphine, and methadone are three FDA-approved drugs prescribed to treat opioid use disorder. However, there are very few studies on the use and safety of naltrexone during pregnancy because the drug is new on the market. In a study published in Clinical Therapeutics, researchers followed mothers and their infants during pregnancy and after delivery from 2017 to 2019. Six of the mothers took naltrexone to treat their opioid use disorder before and during pregnancy, and 12 took buprenorphine. Researchers carefully monitored patients' opioid use, gestational age, birth weight, NICU admission and importantly, NOWS outcomes (i.e., diagnosis, medical treatment, and length of hospital stay).
Astonishingly, the infants born to women taking naltrexone showed no withdrawal symptoms during their initial hospital stays, compared to 92 percent of infants born to women taking buprenorphine. Also, 83 percent of the women in the naltrexone group breastfed, without any immediate harm to their infants in the perinatal period.
Previous studies compared methadone and buprenorphine use during pregnancy and found that buprenorphine was associated with less severe NOWS in infants compared to infants born to mothers who took methadone. Based on the current study, however, it seems that naltrexone may now be preferred over buprenorphine due to positive outcomes for both mother and baby.
Additionally, naltrexone may be safer than buprenorphine because it is administered as an extended-release injection medication, and has a lower risk of overdose or misuse. Perhaps the most important aspect of treating opioid use disorder during pregnancy is keeping mothers stable on their medication to decrease the risk of drug relapse, noted authors.