title: Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers.
abstract: We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period.
authors.affiliation: UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. Electronic address: hendree_jones@med.unc.edu.
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: Department of Family Medicine, Grant Medical Center, Columbus, OH.
authors.forename: Krisanna
authors.initials: K
authors.lastname: Deppen
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine-Jacksonville, FL.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hudak
authors.affiliation: Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Leffert
authors.affiliation: UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC.
authors.forename: Carol
authors.initials: C
authors.lastname: McClelland
authors.affiliation: Pediatric and Maternal Health Staff, Maternal Health Team, Office of New Drugs, Food and Drug Administration, Silver Spring, MD.
authors.forename: Leyla
authors.initials: L
authors.lastname: Sahin
authors.affiliation: Addiction Recovery Program, Brigham and Women's Faulkner Hospital, Boston, MA.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Starer
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Mishka
authors.initials: M
authors.lastname: Terplan
authors.affiliation: UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: Addiction Recovery Service, Swedish Medical Center, Seattle, WA.
authors.forename: James
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D002047:Buprenorphine / Q000627:therapeutic use; D003219:Confidentiality; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy; D007743:Labor, Obstetric; D001523:Mental Disorders / Q000175:diagnosis; D008691:Methadone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D010149:Postoperative Pain / Q000188:drug therapy; D010817:Physician-Patient Relations; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011295:Prenatal Care; D012017:Referral and Consultation; D014218:Triage
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone
keywords: opioid use; opioid-agonist; substance use