Treating Opioid Use Disorder in Pregnancy Cuts Risk of Complications by 30%

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Over the past two decades, the number of pregnant individuals struggling with opioid use disorder (OUD) has surged in the U.S., growing from just 1.5 per 1,000 delivery hospitalizations in 1999 to 8.2 by 2017. While the medical community has long known that opioid use in pregnancy increases risks for both the mother and baby—like preterm birth, severe maternal illness, and even death—many pregnant people still aren’t getting the treatment they need.

A new study published in JAMA Health Forum in April 2025 shines new light on just how critical access to treatment is. Researchers found that pregnant people with OUD who received buprenorphine—a medication used to treat opioid addiction—had significantly better outcomes than those who did not. The study, which tracked over 14,000 mother-infant pairs in Tennessee over a span of 11 years, offers strong evidence that expanding access to buprenorphine could save lives and improve health outcomes across the board.

Buprenorphine is a medication approved to treat opioid addiction. Unlike methadone, which has been the gold standard for decades, buprenorphine is considered safer in many ways. It works by partially activating opioid receptors in the brain—enough to ease withdrawal and cravings, but not enough to produce a high. This “partial agonist” effect means it has a lower risk of overdose, making it a preferred choice during pregnancy.

The Big Question: Does It Help in Pregnancy?

The study set out to answer a crucial question: Does treating OUD with buprenorphine during pregnancy lead to better outcomes for both mother and baby?

The short answer is yes.

Researchers analyzed data from the Tennessee Medicaid program, covering births from 2010 to 2021. Out of 14,463 maternal-infant pairs where the pregnant individual had OUD, just over half (51.6%) received buprenorphine treatment. The other half did not receive any medication for their addiction during pregnancy.

The outcomes were striking.

Key Findings: Buprenorphine Saves Lives and Improves Health

1. Fewer Preterm Births

One of the clearest benefits of buprenorphine treatment was a significant drop in preterm births—babies born before 37 weeks gestation.

Without treatment: 20% of infants were born preterm.
With buprenorphine: Only 14.1% were preterm.

That’s a 30% reduction in the likelihood of delivering prematurely. In adjusted analyses, the odds dropped even further, with a predicted probability of preterm birth at just 11.7% in the treatment group.

2. Lower Risk of Severe Maternal Morbidity (SMM)

Pregnancy is already a physically demanding process, but for those with OUD, the risks skyrocket. The study found that women who received buprenorphine were significantly less likely to experience serious complications such as hemorrhage, cardiac issues, or infection.

Without treatment: 6.9% experienced SMM.
With buprenorphine: Only 5.4% experienced SMM.

That’s a meaningful improvement, particularly when considering that severe maternal complications are often a precursor to maternal death.

3. Reduced NICU Admissions

Babies born to mothers with untreated OUD were also more likely to end up in the neonatal intensive care unit (NICU).

NICU admissions: 17.2% without treatment vs. 15.2% with treatment.

While this might seem like a small difference, it adds up, especially when you consider the strain NICU admissions place on families and the healthcare system.

4. Overall, Fewer Adverse Outcomes

When looking at the big picture—whether it’s SMM, NICU stays, preterm birth, or infant death—the researchers found that just 20 people need to be treated with buprenorphine to prevent one adverse outcome. That’s a remarkably low number in public health terms.

What About the Downsides?

One point that may seem concerning is the increased rate of neonatal opioid withdrawal syndrome (NOWS) in babies whose mothers were treated with buprenorphine, 51.7% compared to 32.4% in the untreated group.

But here’s the nuance: NOWS happens because the baby is exposed to opioids in utero—even if it’s a medically managed dose. While withdrawal symptoms may require treatment, these babies are more likely to be full-term, better nourished, and more resilient than babies born to mothers with untreated OUD, who may also be exposed to street opioids and lack prenatal care.

In short, NOWS is treatable. The more serious outcomes like prematurity, maternal hemorrhage, and ICU admission, carry far more long-term risk.

The study also highlighted a troubling trend: significant racial disparities in who receives treatment.

Only 2.1% of treated individuals were Black, compared to 10.2% of the untreated group.
A separate U.S. government report cited in the study found that just 18% of Black women with OUD received treatment during pregnancy, compared to 48% of white women.

This suggests that Black mothers are not just at higher risk of poor outcomes—they’re also less likely to get the treatment that could help. Bridging this gap must be a priority for health equity moving forward.

Barriers to Treatment: Why Aren’t More Pregnant People Getting Help?

Despite clear benefits, many pregnant people still face barriers to accessing buprenorphine. These include:

Provider reluctance: Some healthcare providers are hesitant to treat pregnant people with OUD due to legal fears or lack of training.
Insurance issues: Even with Medicaid, access to addiction specialists or OBGYNs who prescribe buprenorphine may be limited.
Stigma: Pregnant individuals with substance use disorders often face judgment, which can deter them from seeking care.
Legal consequences: In some states, substance use during pregnancy can lead to child welfare involvement or even criminal charges.

These challenges make it all the more urgent to shift public perception and policy to support treatment—not punishment.

The findings of this study are more than just numbers. They represent real families, real pregnancies, and real lives saved or lost based on access to care.

By using buprenorphine to treat OUD during pregnancy:

Mothers are less likely to face life-threatening complications.
Babies are more likely to be born healthy and full-term.
Families are more likely to thrive, not just survive.

And because the study was done with a large, real-world population over a decade, the results are incredibly relevant to public health programs and policies.

What Needs to Change?

To translate these findings into better outcomes across the U.S., families need:

More providers certified to prescribe buprenorphine—especially those trained to work with pregnant individuals.
Policy reform to remove legal and insurance barriers that prevent people from seeking treatment.
Outreach and education to reduce stigma around OUD in pregnancy.
Equity-focused initiatives to ensure that people of all racial and ethnic backgrounds receive care.

Overall, the study provides evidence that buprenorphine treatment during pregnancy is associated with better outcomes for both the mother and infant compared to no treatment. These include lower rates of preterm birth, severe maternal morbidity, and NICU admissions. While neonatal withdrawal was more common in the treatment group, other serious complications were less frequent.

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