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Case 92 - A 25-Year-Old at 29 Weeks’ Gestation Presents with Opioid Use Disorder and Nausea, Vomiting, and Abdominal Pain

from Section 11 - Psychosocial Considerations

Published online by Cambridge University Press:  08 April 2025

By
Molly Zielenbach
Edited by
Peter F. Schnatz ,
D. Yvette LaCoursiere ,
Christopher M. Morosky ,
Jonathan Schaffir ,
Vanessa Torbenson  and
David Chelmow
Peter F. Schnatz
Affiliation:
The Reading Hospital, Pennsylvania
D. Yvette LaCoursiere
Affiliation:
University of California, San Diego
Christopher M. Morosky
Affiliation:
University of Connecticut School of Medicine
Jonathan Schaffir
Affiliation:
The Ohio State University College of Medicine
Vanessa Torbenson
Affiliation:
Mayo Clinic Alix School of Medicine
David Chelmow
Affiliation:
Virginia Commonwealth School of Medicine
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Summary

Substance use disorders are a major risk factor for maternal mortality, and opioid overdose is a leading cause of maternal mortality in several states. Pregnant and postpartum patients should be assessed for substance use disorders using a validated screening tool, and if present, should be managed with counseling, initiation of pharmacotherapy, and referral for ongoing treatment. Acute presentations of opioid intoxication and opioid withdrawal should be identified and treated. The recommended treatment of opioid use disorder in pregnancy is pharmacotherapy using an opioid agonist. Either buprenorphine or methadone may be appropriate, depending on patient preferences and available treatment resources. Patients should receive education on recognition and prevention of opioid overdose and a prescription for naloxone for overdose reversal.

Keywords

opioidsopiatespregnancysubstancesbuprenorphinemethadoneoverdose
Type
Chapter
Information
Pregnancy Complications
A Case-Based Approach
 , pp. 289 - 291
Publisher: Cambridge University Press
Print publication year: 2025

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References

Wesson, DR, Ling, W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35:253–259.Google ScholarPubMed
American College of Obstetricians and Gynecologists. Opioid Use and Opioid Use Disorder in Pregnancy: Committee Opinion No. 711. Obstet Gynecol. 2017;130:e81–e94.CrossRefGoogle Scholar
American College of Obstetricians and Gynecologists. Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice: Committee Opinion No. 633. Obstet Gynecol. 2015;125:1529–1537.Google Scholar
Substance Abuse and Mental Health Services Administration. Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants. Rockville, MD: SAMHSA; 2018.Google Scholar
The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S):1–91.CrossRefGoogle Scholar
Leeman, L, Starer, J. Medication Assisted Treatment for Opioid Use Disorder during Pregnancy. In: Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge: Cambridge University Press; 2018. 84–92.Google Scholar
Jones, HE. Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant. In: Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge: Cambridge University Press; 2018. 72–83.Google Scholar
Jones, HE, Kaltenbach, K, Heil, SH, et al. Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure. N Engl J Med. 2010;363:2320–2331.Google ScholarPubMed
Minozzi, S, Amato, L, Jahanfar, S, et al. Maintenance Agonist Treatments for Opiate‐Dependent Pregnant Women. Cochrane Database Syst Rev. 2020;11(11):CD006318.CrossRefGoogle Scholar
Waiver Elimination (MAT Act) 2023. www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act (accessed June 14, 2023).Google Scholar

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