Buprenorphine vs methadone during pregnancy

How do the options compare?

This comparison weighs each medication's studied pregnancy safety data, how severe newborn withdrawal tends to be, and how each is actually dispensed day to day, since major guidance names both as effective, evidence-based options rather than ranking one above the other.

• A meta-analysis pooling 3 randomized trials (223 women) and 15 observational studies (1,923 women) linked buprenorphine with a lower chance of preterm birth than methadone: a risk ratio of 0.40 in trial data and 0.67 in observational data. 1
• The same meta-analysis found infants exposed to buprenorphine had higher average birth weight (up to 277 grams more) and larger head circumference than those exposed to methadone, with no meaningful difference between the two medications in fetal anomalies or fetal death. 1
• One trial included in that meta-analysis found more mothers on methadone reported non-serious side effects than mothers on buprenorphine (93% versus 77%), with no difference between the two in serious maternal events. 1
• In a 2023 study of 67 mother-infant pairs, newborns in the combined buprenorphine groups needed medication for opioid withdrawal signs less often than those exposed to methadone (56% versus 87%), and 96% of babies across all groups were born full-term with good Apgar scores. 2
• That same 2023 study found documented illicit drug use during pregnancy was far higher in the methadone group (93%) than in the buprenorphine-based groups (36 to 43%), a pattern the authors linked to methadone patients carrying more complex, multifactorial risk that called for closer monitoring. 2
• CDC guidance names both buprenorphine and methadone as recommended medication options for opioid use disorder in pregnancy, to be started as early as possible, and notes that a pregnant body's changing chemistry, especially in the third trimester, often calls for dose adjustments to either medication. 3
• A Pennsylvania Medicaid study followed 13,320 pregnancies among 10,741 women with opioid use disorder. Longer medication use during pregnancy was associated with continued medication after delivery and lower overdose odds. This observational study examined both medications together, so it does not establish which medication is best for an individual. 4

Which option makes sense?

Buprenorphine's data trends favorable on several newborn measures, but methadone remains a well-studied option with its own decades-long track record, particularly for people who do well with its structured daily dispensing. Consult your healthcare provider, since stopping opioid use without medical support carries its own serious risk to the pregnancy.

Disclosure: Pregnancy Smart makes pregnancy supplements, though not in this category. This comparison is a plain description of the pregnancy evidence, not a sales page.