title: Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment.
abstract: OBJECTIVE
  Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population.
  
  
  RESULTS
  We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad.
  
  
  CONCLUSIONS
  Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Kelley A
authors: KA
authors: Saia
authors: Department of Pediatrics, Boston Medical Center, Boston, USA.
authors: Davida
authors: D
authors: Schiff
authors: Department of Pediatrics, Boston Medical Center, Boston, USA.
authors: Elisha M
authors: EM
authors: Wachman
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Pooja
authors: P
authors: Mehta
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Annmarie
authors: A
authors: Vilkins
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Michelle
authors: M
authors: Sia
authors: Department of Family Medicine, Boston Medical Center, Boston, USA.
authors: Jordana
authors: J
authors: Price
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Tirah
authors: T
authors: Samura
authors: Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
authors: Justin
authors: J
authors: DeAngelis
authors: Boston University School of Public Health, Boston, USA.
authors: Clark V
authors: CV
authors: Jackson
authors: Boston of University School of Medicine, Boston, USA.
authors: Sawyer F
authors: SF
authors: Emmer
authors: Department of Psychiatry, Boston Medical Center, Boston, USA.
authors: Daniel
authors: D
authors: Shaw
authors: Department of Internal Medicine, Boston Medical Center, Boston, USA.
authors: Sarah
authors: S
authors: Bagley
keywords: Breastfeeding; Mental health disorder; Naltrexone; Opioid agonist treatment; Opioid use disorder; Pregnancy; Trauma-informed care