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Neonatal outcomes after antenatal medication for opioid use disorder

Journal of Perinatology (2025)Cite this article

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The American College of Obstetrics and Gynecology (ACOG), Society for Maternal-Fetal Medicine (SMFM), and American Society of Addiction Medicine (ASAM) recommend opioid agonist pharmacotherapy as primary treatment for opioid use disorder (OUD) during pregnancy due to known maternal and neonatal benefits [1]. Although the overall safety of medication for opioid use disorder (MOUD) in pregnancy is well-established and preferred to the risks of untreated OUD and non-prescribed substance use, significant variability in practice and barriers to appropriate use persist [2, 3].

In this issue of Journal of Perinatology, Hall et al. [4] report neonatal outcomes after antenatal MOUD opioid exposure in a large cohort of nearly 750 term and near-term neonates from 13 hospitals in diverse geographic regions in the U.S. The authors focused on infant outcomes of immediate importance to obstetric and neonatal providers and families, including gestational age (GA) at delivery, birthweight, head circumference, need for pharmacologic treatment, breastfeeding, and hospital length of stay. In comparison to antenatal exposure to non-MOUD opioids, antenatal exposure to MOUD opioids (methadone, buprenorphine, buprenorphine/naloxone) was associated with higher rates of breastfeeding and decreased odds of birth before 39 weeks gestation. Among infants antenatally exposed to MOUD opioids, infants exposed to buprenorphine or buprenorphine/naloxone had a higher GA, greater head circumference at birth, higher rates of breastfeeding, a lower rate of pharmacologic treatment for withdrawal, and a shorter length of stay compared to infants exposed to methadone.

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Authors and Affiliations

  1. Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Kristen L. Benninger & Sumana Pothrai

  2. Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA

    Kristen L. Benninger & Robert Nadler

  3. Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA

    Kara M. Rood

Authors
  1. Kristen L. Benninger
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  2. Robert Nadler
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  3. Sumana Pothrai
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  4. Kara M. Rood
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Contributions

KLB participated in conceptualization of the work, drafted the initial manuscript, and participated in editing and critical revision of the article. RN participated in conceptualization of the work and editing, and critical revision of the article. SP participated in conceptualization of the work and editing, and critical revision of the article. KMR participated in conceptualization of the work, drafted the initial manuscript, and participated in editing and critical revision of the article. All authors have reviewed and approved the final manuscript and accept responsibility for its integrity.

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Correspondence to Kristen L. Benninger.

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Benninger, K.L., Nadler, R., Pothrai, S. et al. Neonatal outcomes after antenatal medication for opioid use disorder. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02500-0

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