If you are currently pregnant and using kratom, the most important thing this article can tell you is this: make an appointment with your OB/GYN, midwife, or other prenatal care provider before making any changes to your kratom use. Do not stop abruptly on your own. Do not start a self-directed taper without clinical guidance. Call your provider first.
The reason is specific and important: kratom has opioid receptor activity, and abrupt cessation of opioid-receptor-active substances during pregnancy carries documented risks — not just to you, but to the fetus. This is not a reason to continue using kratom. It is a reason to make any changes under medical supervision rather than on your own.
TL;DR: Kratom use during pregnancy is associated with neonatal withdrawal risk (neonatal opioid withdrawal syndrome, or NOWS). There is limited but concerning clinical evidence. The appropriate clinical path for pregnant people using kratom is prescriber involvement — typically an OB/GYN with addiction medicine experience or a referral to maternal-fetal medicine. Buprenorphine (Suboxone) is FDA-approved for opioid use disorder in pregnancy and may be recommended instead of abrupt kratom cessation. No changes to kratom use during pregnancy should be made without medical guidance.
What the evidence shows
The clinical literature on kratom use in pregnancy is limited — kratom use is relatively recent in the United States, and prospective studies on pregnancy outcomes are sparse. What exists is primarily case reports and emerging registry data.
The documented concerns:
Neonatal opioid withdrawal syndrome (NOWS): There are published case reports of NOWS in infants born to mothers who used kratom during pregnancy. NOWS involves the newborn experiencing opioid withdrawal after birth, which can include tremors, poor feeding, irritability, and in some cases respiratory distress requiring neonatal intensive care. The risk appears to be real based on available case data.
Limited data on fetal development: The long-term effects of kratom alkaloid exposure on fetal development are not well characterized in the literature. Kratom's opioid receptor activity during critical developmental periods is a recognized concern, though the magnitude of risk is not precisely quantified.
Interaction with pregnancy-related physiological changes: Kratom is metabolized by CYP enzymes; pregnancy alters CYP activity significantly, which can change how kratom is processed. This means dosing equivalents from pre-pregnancy may not hold during pregnancy.
What the evidence does not support: safe levels of kratom use during pregnancy. There is no established "safe" dose of kratom during pregnancy in the same way there is no established safe dose of other opioid-receptor-active substances.
Why abrupt cessation during pregnancy is not the right first step
For people not pregnant, stopping kratom abruptly is sometimes appropriate — the withdrawal is unpleasant but manageable for most leaf-powder users. During pregnancy, this calculation changes.
Opioid withdrawal during pregnancy — including withdrawal from opioid-receptor-active substances like kratom — has been associated with risks to the pregnancy, including preterm labor and fetal stress. The physiological stress of withdrawal affects both the mother and the fetus. This is not a reason to continue kratom indefinitely during pregnancy — it is a reason to manage any changes to kratom use medically rather than on your own.
The clinical approach for pregnant people with opioid-receptor dependence has shifted significantly in recent decades. Buprenorphine maintenance is now the recommended clinical approach for opioid use disorder in pregnancy — it stabilizes the opioid receptor situation, prevents the risks associated with active withdrawal, and has better documented pregnancy outcomes than either continued illicit opioid use or abrupt cessation without support. The decision about whether buprenorphine is appropriate, and at what dose, belongs with an OB/GYN or addiction medicine specialist who can evaluate the full clinical picture.
If you are trying to conceive
If you are using kratom daily and planning to become pregnant, the appropriate time to address kratom use is before conception — not during pregnancy. A prescriber conversation before trying to conceive allows for a planned taper or transition to a clinically managed alternative, timed so that you are either off kratom or on a stable, clinically managed regimen before pregnancy begins.
This is significantly less complicated than managing the situation during pregnancy. If you are in this position, the relevant conversations to have now are with your primary care provider or a reproductive medicine specialist, and potentially with a MAT-experienced prescriber about what transition options look like.
How to get help
If you are pregnant and using kratom:
- Call your OB/GYN, midwife, or prenatal care provider first
- If you don't have prenatal care, access it immediately — most states have Medicaid coverage for pregnancy, and federally qualified health centers provide care regardless of ability to pay
- Ask your provider about maternal-fetal medicine referral if your situation involves complex substance use
- SAMHSA's helpline (1-800-662-4357) can connect you to substance use resources for pregnant people, including programs that specialize in this clinical situation
If you are concerned about legal or custody implications of disclosing kratom use to your provider:
- Most states have legal protections for pregnant people who disclose substance use and seek treatment
- Medical disclosure to your OB/GYN is confidential under HIPAA
- Not disclosing and not getting care carries higher risk than disclosing and working with your provider
- A lawyer or patient advocate through a harm-reduction organization (like the National Advocates for Pregnant Women — pregnancyjustice.org) can advise on your specific state's legal landscape if this is a concern
The honest framing
Using kratom during pregnancy is a complicated situation, and arriving at it wasn't simple. The judgment that matters now is what to do from here — and the honest answer is that the right path forward requires clinical partnership, not self-management.
Your OB/GYN has seen complicated situations before. The clinical community has become significantly more skilled and less punitive in addressing substance use during pregnancy than it was even a decade ago. The goal — a healthy pregnancy and a healthy newborn — is shared.
Make the call.
This article is not a substitute for clinical care. If you are pregnant and using kratom, contact your prenatal care provider before making any changes to your use pattern.
If you are in crisis, call or text 988 (Suicide and Crisis Lifeline) or call 911. For immediate concerns about your pregnancy, contact your OB/GYN or go to your nearest emergency room.