Important context before reading. This article is general clinical information, not medical advice for your pregnancy. Every pregnancy is individual, and decisions about kratom use, withdrawal, or medication during pregnancy must be made with your OB and an addiction medicine provider together. Call 423-498-2000 before making any sudden changes to use.
Why This Matters
Kratom’s active alkaloids — mitragynine and 7-hydroxymitragynine (7-OH) — activate the same mu-opioid receptors that prescription opioids and other full agonists activate. That means kratom use during pregnancy has two categories of risk that map closely onto opioid use during pregnancy: risks from the substance itself, and risks from uncontrolled withdrawal.
Neither risk is zero, and the right decision isn’t “stop immediately by any means necessary.” Cold-turkey withdrawal during pregnancy is a known cause of fetal stress and can be dangerous. The clinically supported path in almost every case is medication-assisted treatment with OB involvement, not abrupt cessation.
The Risks of Continued Kratom Use During Pregnancy
The peer-reviewed literature on kratom in pregnancy is still small, but case reports and surveillance data describe:
- Neonatal opioid withdrawal syndrome (NOWS), also called NAS. Babies born to mothers using opioid-type substances regularly — including kratom — can experience withdrawal after delivery. Symptoms include tremor, high-pitched crying, feeding difficulty, sleep disruption, and GI distress. NOWS is treatable but requires NICU observation and often medication for the newborn.
- Low birth weight and preterm delivery have been associated with opioid-type substance use during pregnancy, including kratom in some case reports.
- Placental transfer. Kratom alkaloids cross the placenta. What’s in the parent’s bloodstream reaches the fetus.
- Variable product quality. The unregulated kratom market means potency, purity, and concentrated 7-OH content can vary unpredictably between and within products. This is a particular concern because the supply is not standardized to the level a medical product would be.
Why Stopping Abruptly Is Also Risky
Sudden cessation of any opioid-type substance during pregnancy can cause acute fetal stress. Pregnant patients going through opioid withdrawal are at higher risk for:
- Miscarriage or preterm labor
- Placental abruption (a medical emergency)
- Severe maternal withdrawal symptoms that may lead to relapse and overdose
- Meconium passage in utero (fetal distress)
This is why the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM) both recommend against unmanaged withdrawal during pregnancy for opioid use disorder — and the same reasoning applies to kratom dependence. The safer path is stabilization on an appropriate medication, not cold-turkey abstinence.
Buprenorphine in Pregnancy: The Clinical Evidence
Buprenorphine — the active ingredient in Suboxone, Subutex, Sublocade, and Brixadi — has been used in pregnant patients with opioid use disorder for years, and the accumulated evidence generally supports its use when the alternative is continued illicit use or unmanaged withdrawal. Published outcomes from studies of buprenorphine during pregnancy consistently show:
- Stabilization of maternal opioid activity on receptors (reducing fetal stress cycles)
- Reduced rates of preterm birth vs. untreated opioid use disorder
- Typically milder NOWS in the newborn compared to methadone-exposed infants, though some risk remains
- Better maternal engagement with prenatal care when addiction is treated
For kratom dependence specifically, buprenorphine is the same medication you’d use for any opioid-type dependence, and the pharmacology works the same way.
Subutex vs. Suboxone in Pregnancy
A specific clinical question comes up for pregnant patients: should the medication be Suboxone (buprenorphine + naloxone) or Subutex (buprenorphine alone)? Historically, some providers preferred Subutex during pregnancy on the theory that fetal exposure to naloxone should be minimized. Current practice has shifted — recent evidence suggests Suboxone is acceptable in pregnancy too, and several large studies have not found meaningful differences in outcomes. But the decision is made case by case between the patient, the MAT provider, and the OB.
Some providers and OBs still prefer Subutex for pregnancy out of an abundance of caution. That’s a reasonable clinical stance. We can prescribe either, based on what fits your specific situation.
How OB Coordination Works
Pregnancy on MAT involves two clinical teams working together:
- Your OB handles prenatal care, delivery planning, and newborn observation for NOWS. They need to know you’re on buprenorphine so they can plan delivery and postnatal care appropriately.
- Our MAT team handles the buprenorphine prescription, dose adjustments through pregnancy (dose requirements often change in the third trimester due to increased metabolism), and your overall addiction care.
The coordination piece matters. With your written consent, we share relevant clinical information with your OB so your delivery team knows what to expect and has the baby’s care team ready. Under 42 CFR Part 2, no information leaves our clinic without your written consent — even to your OB — but signing that release is almost always a good idea during pregnancy because it keeps everyone on the same page.
If you don’t currently have an OB and you’re pregnant and kratom-dependent, our team can help you find one who has experience with MAT patients. It’s worth asking at intake.
Breastfeeding on Buprenorphine
Breastfeeding while on buprenorphine is generally considered compatible. Buprenorphine passes into breast milk in small amounts, and current guidance from major medical organizations is that the benefits of breastfeeding for both parent and baby typically outweigh the small exposure. Your OB, your pediatrician, and our team will discuss this with you as delivery approaches.
Post-Delivery Care
Staying on MAT after delivery is the standard recommendation. The first year postpartum is a statistically higher-risk period for relapse in substance use disorders generally, and dropping the medication right after delivery — when sleep deprivation, hormonal shifts, and the stress of newborn care stack up — is not clinically advised. Your MAT provider will work with you on any dose adjustments postpartum and will maintain the medication through the postpartum year and beyond as clinically appropriate.
Your newborn will be observed for NOWS and treated if needed — most cases are manageable and resolve within days to weeks.
What to Do Today
If you’re pregnant and using kratom:
- Do not stop abruptly. Seek medical guidance first.
- Call our intake team: 423-498-2000. Tell them you’re pregnant and using kratom. We’ll schedule you for an urgent-priority evaluation.
- If you have an OB already, let us know who they are so we can coordinate from the first visit.
- If you don’t have an OB, call your insurance’s nurse line or a nearby OB practice today — we’ll help you navigate this at your MAT intake.
- Keep taking kratom as you normally would until your provider gives specific guidance about stopping. Sudden cessation is the thing to avoid.