title: Opioid addiction in pregnancy.
abstract: The purpose of this review is to discuss the incidence, risks, pregnancy complications, and maintenance options for treatment of opioid addiction in pregnancy.
  
  
  CONCLUSIONS
  Opioid dependence in pregnancy carries clear identifiable maternal and fetal risk. Providing care for patients with dependence is best done in a multidisciplinary care model addressing the particular needs of this population. There are limited data on maternal detoxification, with data still emerging surrounding the safety profile of this practice. Historically, methadone has been the recommended maintenance treatment; however, recent data on buprenorphine identify this as a safe and effective option. The majority of births from women with opioid dependence result in neonatal abstinence syndrome requiring prolonged neonatal hospitalization. Intrapartum pain management should not differ from the general obstetric population. Postpartum pain is magnified in this population, and particular attention should be focused on this issue. Breast-feeding is recommended regardless of maintenance dose, unless other conditions restricting breast-feeding are present. Comprehensive postpartum care and transition of care to addiction specialists are highly recommended.
  
  
  BACKGROUND
  Obstetricians and gynecologists, family physicians, addiction specialists.
  
  
  OBJECTIVE
  After completing this CME activity, physicians should be better able to assess the treatment options available to patients with opioid addiction during pregnancy, compare the risk/safety profiles of methadone and buprenorphine, and evaluate the recommendations and current data surrounding breast-feeding while on opioid maintenance treatment.
authors.affiliation: Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA 02118, USA. scott.shainker@bmc.org
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shainker
authors.forename: Kelley
authors.initials: K
authors.lastname: Saia
authors.forename: Aviva
authors.initials: A
authors.lastname: Lee-Parritz
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D001942:Breast Feeding; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000209:etiology*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D059408:Pain Management; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone