Treatment of Opioid Use Disorders in Pregnancy

These resources offer guidelines for the use of Medication-Assisted Treatment (MAT) to treat opioid use disorders in pregnancy and the post-partum period. Included is information on breastfeeding while using MAT, the use of buprenorphine with pregnant women, and resources on the treatment of other substance use disorders in pregnancy.

Publications

Substance Use Screening and Reproductive Education and Counseling for Substance Using Women of Child-bearing Age

Substance Use Screening and Reproductive Education and Counseling for Substance Using Women of Child-bearing Age: Online training from the Providers’ Clinical Support System for Medication-Assisted Treatment and the American Society of Addiction Medicine. Reviews the importance of screening for substance use during prenatal care and reproductive education and counseling content that can be integrated into substance treatment. http://pcssmat.org/substance-use-screening-and-reproductive-education-and-counseling-for-substance-using-women-of-child-bearing-age-asam/

Opioid Abuse, Dependence, and Addiction in Pregnancy

American Congress of Obstetricians and Gynecologists (ACOG), Committee on Health Care for Underserved Women and the American Society of Addiction Medication (ASAM): Committee Opinion, Opioid Abuse, Dependence and Addiction in Pregnancy. Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. It is the Committee’s opinion that the current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should also be considered. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy

Guidelines for identification and management of substance use and substance use disorders in pregnancy

World Health Organization: Guidelines for Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. These guidelines contain recommendations on the identification and management of substance use and substance use disorders for health care services which assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder. They have been developed in response to requests from organizations, institutions and individuals for technical guidance on the identification and management of alcohol and other substance use and substance use disorders in pregnant women, with the target of healthy outcomes for both pregnant and their fetus or infant. http://www.who.int/substance_abuse/publications/pregnancy_guidelines/en/

TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women

Treatment Improvement Protocol (TIP) 51: Substance Abuse Treatment, Addressing the Specific Needs of Women. Assists treatment providers in offering treatment to adult women with substance use disorders. Reviews gender-specific research and best practices, such as common patterns of initiation of substance use among women and specific treatment issues and strategies. http://store.samhsa.gov/product/TIP-51-Substance-Abuse-Treatment-Addressing-the-Specific-Needs-of-Women/SMA14-4426

Marijuana Use During Pregnancy and Lactation

American Congress of Obstetricians and Gynecologists (ACOG), Committee on Obstetric Practice: Committee Opinion, Marijuana Use During Pregnancy and Lactation. This article describes the ACOG Committee Opinion to discontinue use of medical or recreational marijuana during pregnancy and while breastfeeding. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation

Medication for the Treatment of Alcohol Use Disorder: A Brief Guide

Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. Includes information on considerations for the treatment of alcohol use disorders in pregnancy. Provides guidance for the use of medication-assisted treatment for alcoholism and alcohol abuse in clinical practice. Summarizes approved medications and discusses screening and patient assessment, treatment planning, and patient monitoring. http://store.samhsa.gov/shin/content//SMA15-4907/SMA15-4907.pdf (PDF 507 KB)

Pregnant Women & Prescription Drug Abuse, Dependence and Addiction

The American Congress of Obstetricians and Gynecologists (ACOG) Toolkit on State Legislation: Pregnant Women & Prescription Drug Abuse, Dependence and Addiction. This toolkit provides talking points and policy recommendations from ACOG for state legislators and other policy organizations that are addressing pregnant women and prescription opioid use during pregnancy. http://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/NASToolkit.pdf (PDF 287 KB)

Webinars and Videos

  • WebinarMedication-Assisted Treatment During Pregnancy, Postnatal and Beyond: Discusses the needs of pregnant women seeking medication-assisted treatment. Karol Kaltenbach, PhD presents findings from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project. Facilitated as part of a webinar series.
  • Indian Health Services Webinar Series: Addresses various issues, including Illicit Drug Use around the Time of Birth, Education and Prevention Strategies. https://www.ihs.gov/telebehavioral/seminararchive/substanceuse/
  • Texas State Department of Health Services, Journeys of Hope, Mommies and Babies Overcoming Neonatal Abstinence Syndrome Video: Three mothers describe their experience in recovering from opioid use disorders during pregnancy. Professionals from child welfare, substance use treatment and the medical field discuss how providing care without judgment results in better outcomes for both mom and baby. http://www.dshs.state.tx.us/sa/nas/#journeys

Recent Research Studies

hand holding pen writing on paperStudies on the use of methadone and buprenorphine for the treatment of opioid use disorders during pregnancy:

  • Jones, H.E., Fishcer, G., Heil, S.HG., Kaltenbach, K., Martin, P.R., Coyle, M.G., Selby, P., Stine, S.M., O’Grady, K.E. & Arria, A.M. (2012). Maternal Opioid Treatment: Human Experimental Research (MOTHER) – approach, issues and lessons learned. Addiction, 107, 28-35. doi: 10.1111/j.1360-0443.2012.04036.x.

    A National Institute on Drug Abuse (NIDA)-supported clinical trial that examined the use of methadone and buprenorphine maintenance therapy during pregnancy. No significant difference was found with respect to any serious maternal or neonatal adverse events. http://www.ncbi.nlm.nih.gov/pubmed/23106924
  • Hall, E.S., Isemann, B.T., Wexelblatt, S.L., Meinzen-Derr, J., Wiles, J.R., Harvey, S., & Akinbi, H.T. (2016). A cohort comparison of buprenorphine versus methadone treatment for neonatal abstinence syndrome. The Journal of Pediatircs, 170, 39-44. doi: http://dx.doi.org/10.1016/j.jpeds.2015.11.039.

    This study compared the duration of opioid treatment and length of stay among infants treated for neonatal abstinence syndrome (NAS) by using a pilot buprenorphine versus conventional methadone treatment. Results indicated that sublingual buprenorphine may be superior to methadone for management of NAS in infants with select intrauterine opioid exposures.protocol. http://www.jpeds.com/article/S0022-3476(15)01451-1/abstract
Treatment of Opioid Use Disorders in Pregnanc
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