Objective: To review the literature about the association between breastfeeding and neonatal abstinence syndrome (NAS) severity, need for pharmacologic treatment for NAS, and length of hospital stays in neonates with in-utero exposure to methadone or buprenorphine opioid replacement therapy.

Data sources: PubMed, CINAHL, and Medline were searched for articles published between January 1990 and April 2013 using the terms opioid dependency in pregnancy, neonatal abstinence syndrome, methadone, buprenorphine, neonatal length of stay, breastfeeding, methadone in breast milk, buprenorphine in breast milk, swaddling, and rooming-in.

Study selection: Inclusion criteria included studies written in English on the topic of breastfeeding for management of NAS.

Data extraction: The author independently reviewed each article.

Data synthesis: Breastfeeding can effectively decrease NAS symptoms because methadone and buprenorphine are transferred to the breast milk. Maternal contact while breastfeeding also plays a role in ameliorating the NAS symptoms. Interventions that also support breastfeeding in the treatment of NAS include skin-to-skin contact, swaddling, and rooming-in.

Conclusions: Understanding the benefits of breastfeeding for opioid-dependent pregnant women and their neonates will enable clinicians to safely recommend breastfeeding for long-term health of these high-risk women and their infants. This review of the effects of in-utero exposure to opioids on infant development can assist clinicians to more effectively support opioid-dependent women to breastfeed their infants.