Buprenorphine crosses the placenta and is poorly metabolized, and large portions of the drug are sequestered in the oral mucosa and released slowly, thus decreasing the amount of drug that is transferred to the fetus. Buprenorphine does appear transfer through breast milk, although studies are limited, and levels of the drug in breast milk fluctuate with time after maternal dosing. Due to limited gastrointestinal absorption when taken orally, the amount of buprenorphine transferred to the breastfeeding infant is likely extremely low and unlikely to cause adverse effect. To date, buprenorphine is available as both buprenorphine alone (Subutex) or buprenorphine and naloxone pregnancy is associated with reduced rates of preterm births, longer gestation and increased birth weights.
The guidelines for management of opioid addiction in pregnancy include maintenance therapy with methadone or buprenorphine in addition to traditional prenatal care and psychosocial treatment of substance abuse, such as self-help, 12 step groups, individual and group substance abuse counseling and psychotherapy.