Over the past two decades, deaths related to substance use have more than doubled among women of reproductive age. Overdoses are now a prominent cause of maternal mortality in the U.S., being the leading factor in some states.
Yet, there remain significant gaps in understanding how different treatment approaches impact the short- and long-term health of mothers and infants, as well as their broader economic effects over time.
A recent study published in the journal JAMA Pediatrics has found that established opioid use disorder medications for pregnant women—buprenorphine and methadone—both outperform alternative treatments (naltrexone, medication-assisted withdrawal, or no treatment) in terms of health benefits and cost savings. However, buprenorphine yielded the greatest health gains and cost reductions for both mothers and infants.
JAMA PediatricsThe research used a mathematical simulation model to project health and cost outcomes over a lifetime for pregnant individuals with opioid use disorder and their babies. The study revealed how pregnancy treatment decisions can have enduring health and economic consequences, including risks of preterm birth that affect both children and adults and lead to significant downstream health effects and costs.
Outpatient buprenorphine proved to be the most effective treatment in the majority of scenarios tested (58–100%) and nearly all lifetime scenarios involving both mother and child trajectories (99%). Across thousands of simulations, buprenorphine consistently demonstrated superior health outcomes and lower costs compared to other strategies.
Led by Ashley Leech, Ph.D., assistant professor at Vanderbilt University Medical Center, and Stephen Patrick, MD, MPH, O. Wayne Rollins Distinguished Professor and chair at Emory University's Department of Health Policy and Management, the study is among the first to compare the short- and long-term health benefits and costs of opioid use disorder treatments for mothers and their infants using simulation modeling.
Previous studies failed to examine outcomes past an infant’s first year. The research applied a hypothetical treatment group based on known demographic factors to estimate differences in long-term outcomes for each treatment approach.
The paper concluded that although Neonatal Opioid Withdrawal Syndrome (NOWS) often garners clinical focus as an indicator of poor infant health after opioid exposure, preterm birth and low birth weight have higher morbidity and mortality rates. Despite its association with NOWS, buprenorphine was shown to be protective against these critical outcomes.
"Nationally, we've seen a rise in pregnant women with opioid use disorder but lack comprehensive models assessing different medications and strategies," said Patrick. "This study evaluated the trade-offs clinicians face: how will medications affect mothers and babies?"
"Based on current evidence, what can we expect years from now? Ultimately, we found that buprenorphine treatment during pregnancy was cost-saving and improved outcomes for both mothers with opioid use disorder and their babies."
Nevertheless, the researchers emphasized that patient-centered care remains vital.
"While buprenorphine showed the greatest health gains and cost reductions across various model scenarios, methadone still offers value for some. For individual patients, it might be more effective," noted Leech, lead author of the study.
Buprenorphine provides clear advantages for long-term infant outcomes but can be harder to begin and sustain due to its nature as a partial agonist. Methadone, in contrast, can often be easier for patients to start and maintain.
"This is an opportunity to optimize buprenorphine’s effectiveness by ensuring pregnant individuals receive effective doses across trimesters (as pregnancy increases drug needs compared to nonpregnant patients) and removing unnecessary Medicaid restrictions."
According to the study, significant cost savings could be achieved for public insurance programs like Medicaid, potentially saving nearly $4 billion in infant-related lifetime costs.
"Medicaid is the largest payer for pregnant individuals and those with substance use disorders. Our research shows that treatment isn't just effective but can generate substantial savings for Medicaid, benefiting both mothers and their children’s long-term health," Leech said.