Methadone and Pregnancy — Safety, Risks, and Effects

It is essential that we ensure the safety of both maternal and fetal health, rather than leaving it to chance. As a precaution, the risks of methadone and pregnancy must be carefully assessed to minimize any harm. Methadone is an opioid agonist used as an analgesic, mostly to replace natural opioids, especially in cases of opioid addiction.

Methadone is long-acting and does not promote the euphoric effect seen in natural opioids such as morphine and heroin. For chronic conditions with associated pain, use methadone for relief. The long-term use of this medication can, however, have effects when used during pregnancy.

Methadone and Pregnancy

Can You Take Methadone While Pregnant?

A person can use opioids to relieve pain, but they can also experience a sense of euphoria that could lead to misuse of the medications. The safety of the fetus is important, which is why there is a need to understand the substances that can be beneficial or harmful during pregnancy. Is methadone safe for pregnancy? Yes! In opioid use disorder, methadone is one of the safest medications to use during gestation. It helps to replace the use of natural opioids without the additional risk of addiction if used within the appropriate dosage.

Some possible risk factors exist for using methadone during pregnancy. Miscarriage can occur in any pregnancy due to different reasons. A review of methadone use during pregnancy has not clearly shown the link between it and the occurrence of miscarriage. A study showed that there is a higher risk of birth defects when used during the first trimester. It is always better to have your healthcare provider guide you through your drug use during the pregnancy period.

Medication-assisted treatment is usually the line of action for cases of opioid use disorder, even during pregnancy. This requires the use of medications like methadone or buprenorphine. Untreated opioid use disorder during pregnancy could result in an increased occurrence of stillbirth, maternal mortality, and neonatal abstinence syndrome. When healthcare providers introduce the use of methadone, they reduce the risks and increase the chances of a safe birth.

Managing Methadone Use During Pregnancy

Methadone pregnancy is a safe medication-assisted treatment therapy for mothers who have been on opioids with a possibility of opioid misuse. This is because of its pharmacokinetic properties, such as its half-life (20-35 hours), which ensures the slow release of its metabolites into the tissues. This property is particularly important because one daily dose can be sufficient without the risk of misuse or withdrawals.

The physiologic changes in a woman during pregnancy have led to different thoughts about increasing the dosage of methadone in pregnancy. These changes include total body volume, blood volume, and body fat. During the gestation period, the increasing total blood volume can lead to a reduction in serum methadone levels due to dilution. The liver’s enzymatic action can alter the metabolic rate of methadone from the first trimester to the third trimester.

These alterations result in varying concentrations of methadone during pregnancy. However, monitoring serum methadone levels is not a common practice. Clinicians adjust the dosage of methadone depending on the symptoms of overdose and withdrawal seen. This is why the use of this medication should be in a controlled environment with routine checks by your doctor. To minimize the risks associated with the use of methadone in pregnancy, ensure you follow the prescribed dosage for use by your doctor, also, seek immediate medical attention if you notice any signs associated with methadone overdose.

Is Methadone Safe During Pregnancy?

Methadone is still the safest medication to use in pregnancy for a patient who has a history of opioid use disorder. There are some risk factors associated with its use, but they are still much better than those associated with the use of natural opioids. There is growing evidence that suggests that there could be an alteration in the fetal brain and the risk of cognitive problems with exposure to methadone.

Short-Term Effects of Methadone Exposure in Utero

Maternal health showed the most significant short-term effects from methadone exposure, as evidenced by methadone overdoses or acute withdrawal symptoms from opioids. Some common signs of this could be anxiety, constipation, dizziness, confusion, and irregular blood pressure. While starting on methadone, it is important to titrate the doses to withstand the varying concentrations of methadone in the serum throughout pregnancy.

Long-Term Effects of Babies Born on Methadone

Patients who use methadone for chronic pain throughout gestation exhibit long-term effects. These effects have a more significant role to play in the life of the child after birth. Here are some of the long-term effects of methadone exposure seen in babies:

  1. Development outcomes: The use of methadone impairs cognitive and behavioral development with an associated risk. Some studies have compared the findings seen in non-methadone use and those with methadone use during pregnancy. A result showed that those with methadone use have lower motor, cognitive, and language scores compared to those without its use.
  2. Methadone during pregnancy and autism: People with autism exhibit repetitive behaviors, have difficulty with nonverbal communication, and display poor social skills. During pregnancy, methadone can cross the placental barrier. Methadone also acts on the μ-opioid receptor which is the same receptor for natural opioids. The balance between the activation of this receptor and its deactivation could tilt the developmental process of the fetus negatively. During pregnancy, it is essential to carefully control the use of methadone. Too much of its use could be a potential risk for autism.

Caring for Newborns with Prenatal Methadone Exposure

Newborns with prenatal methadone exposure require special care. This will help to identify early symptoms of possible effects of the medication and a comprehensive process to ensure its management.

A common effect of prenatal methadone exposure seen in newborns is the Neonatal Abstinence Syndrome (NAS). This is a spectrum of clinical symptoms seen in neonates due to the withdrawal of intrauterine medication. During pregnancy, a prolonged period of natural opioid exposure is mostly seen as having these effects. However, it can also occur with the use of methadone, especially when used in combination with natural opioids and throughout the gestation period. Some signs and symptoms of this include:

  • Tremors
  • Convulsion
  • Slow weight gain
  • Blotchy skin
  • Fever
  • Inability to sleep well

The goal of treatment for this syndrome involves a planned process to reduce withdrawal symptoms and to gradually help the baby adjust to not having doses of the medication. There would be a need for a neonatal and pediatric specialist to play their definitive roles in the management of the baby. When properly treated, babies recover within 5 to 30 days.

Can You Breastfeed on Methadone?

For patients who have to use methadone for opioid use disorder, it is safe to go ahead with breastfeeding while using the medication. Studies have shown that the exposure of infants to methadone is minimal through breastfeeding. You should also consult with your healthcare provider for better assessment and guidance.

Are There Alternatives to Methadone During Pregnancy?

Suboxone is a common alternative to use in the absence of methadone while treating opioid use disorder during pregnancy. It is a brand name for a combination of buprenorphine and naloxone. Buprenorphine is a partial agonist at the same μ-opioid receptor. This makes it less likely to result in an overdose compared to methadone. Taking Suboxone during pregnancy is safe as it acts in a similar way to methadone. There is, however, a risk of neonatal abstinence syndrome, as seen with methadone and other natural opioids.

The treatment of opioid use disorder during pregnancy is not just a medication-based therapy. There is also a need for supportive care and behavioral therapy. You most definitely need to get a rehab center that caters to pregnant women to seek support as demanded.

Finding Quality Treatment and Support

There are different methadone clinics suitable for pregnant women to go through this phase healthy with the right support. An individualistic program, geared towards providing holistic care, is offered by these rehab centers.

The programs can be inpatient or outpatient depending on your treatment needs. There is usually a support group where patients with similar medical histories interact with you in the form of a community, just to give you the required support and motivation needed. Here are some important points to note while choosing a support center:

  • The licensing body must register and accredit the center.
  • Healthcare professionals should be available to address relevant areas during treatment.
  • Ensure that the center caters to the needs of pregnant women, including facilities that can help during the treatment phase.
  • You should ensure that the location and cost meet your expectations, especially since you will be seen as an outpatient.
  • Before registering to commence therapy, one should check the previous testimonials and reviews from such centers.

You can do the necessary research on these to ensure that you are in the right place with the right support you need.


Methadone is a safe drug for use during pregnancy as it offers a lesser risk of developmental anomalies in the fetus compared to other natural opioids. A pregnant woman undergoing opioid use disorder may require the chronic use of methadone, which involves certain risks but can be effectively managed in an appropriate support environment.

You should always have your doctor review the decision to use methadone during pregnancy. During the treatment therapy, the professional will identify and address other associated risk factors, as well as provide necessary support therapy. After birth, monitor the signs and symptoms associated with methadone risk factors in newborns and provide necessary healthcare intervention in methadone clinics if needed.