Lower chance of adverse maternal-infant outcomes with buprenorphine for OUD

Women with opioid use disorder (OUD) treated with buprenorphine during pregnancy had significantly lower rates of adverse maternal and infant outcomes than those who did not receive treatment, according to a study presented at PAS 2025.

Following its approval by the FDA in 2002, buprenorphine has become the dominant medication used to treat OUD in the US, largely due to state and federal policies, said lead author Sunaya Krishnapura, a medical student at Vanderbilt University School of Medicine in Nashville, Tennessee, US.

Using data from the Tennessee Medicaid (TennCare) database, Krishnapura and her team retrospectively analysed 14,463 mother-infant dyads continuously enrolled in TennCare from 20 weeks’ estimated gestational age to 6 weeks postpartum between 2010 and 2021. The study included mothers with an OUD diagnosis (median maternal age 27 years), of whom 7,469 received buprenorphine treatment, while the remaining 6,994 did not.

According to the results, the rate of adverse pregnancy outcomes was significantly lower in the buprenorphine-treated group compared with the untreated group (25.4 percent vs 30.8 percent (p<0.001). [Krishnapura S, et al, PAS 2025]

In particular, mother-infant dyads treated with buprenorphine had significantly lower rates of severe maternal morbidity (5.4 percent vs 6.9 percent; p<0.001), preterm birth (14 percent vs 20 percent; p<0.001), and neonatal intensive care unit (NICU) admission (15.2 percent vs 17.2 percent; p=0.001) than those who did not receive treatment.

After adjusting for covariates, dyads treated with buprenorphine had a 5.1-percent lower probability of adverse pregnancy outcomes compared with untreated dyads (23.04 percent vs 28.10 percent).

As assessed individually, mothers receiving treatment had a 1.2-percent lower probability of experiencing severe maternal morbidity than those not receiving treatment (5.01 percent vs 6.22 percent).

Infants born to mothers treated with buprenorphine had a 1.7- and 5.3-percent lower probability of NICU admission (13.81 percent vs 15.46 percent) and being born preterm (11.65 percent vs 16.97 percent), respectively, compared with those born to mothers who did not receive treatment.

“Taken together, we found that buprenorphine treatment was associated with a lower likelihood of adverse pregnancy outcomes for both mothers and infants,” said Krishnapura.