How is medication-assisted treatment adapted for pregnant patients with opioid use disorder?

• A. Discontinue all MAT during pregnancy
• B. Methadone or buprenorphine maintenance is preferred during pregnancy; monitor neonatal withdrawal; coordinate obstetric and addiction care; avoid precipitating withdrawal
• C. Naltrexone is preferred in pregnancy
• D. Buprenorphine only approved for pregnancy

Answer: (B)

During pregnancy, the goal is to maintain a stable opioid treatment to prevent withdrawal, reduce cravings, and lower the risk of relapse, while coordinating care for both mother and fetus. Methadone or buprenorphine maintenance achieves this best because they provide steady receptor stimulation and support ongoing prenatal care, rather than risking sudden withdrawal or illicit opioid use. As pregnancy changes a person’s physiology, dosing may need careful adjustment and close monitoring, but stopping MAT or attempting rapid detox can trigger fetal distress and adverse pregnancy outcomes. Neonatal withdrawal is a known possibility after birth, so planning for NAS assessment and appropriate neonatal care is essential. Coordination between obstetric and addiction treatment teams ensures the pregnancy progresses safely and NAS is managed effectively. Avoiding precipitous withdrawal is key, which is why abrupt discontinuation or using opioid antagonists like naltrexone during pregnancy is not appropriate. The overall approach values continuity of MAT with methadone or buprenorphine, integrated prenatal care, and a plan for NAS after delivery.