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Chapter 76 - Opioid Use Disorders in Pregnancy

from Section 13 - Miscellaneous Conditions

Published online by Cambridge University Press:  23 February 2023

By
Tricia E. Wright  and
Amira El-Messidi
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

A 25-year-old primigravida at 21+5 weeks’ gestation is sent by her primary care provider for urgent consultation and transfer of care to your tertiary center’s high-risk obstetrics unit for increasing diaphoresis, body aches, and anxiousness since self-discontinuation of heroin upon recent knowledge of pregnancy.

Keywords

Opioid use disorder, addiction medicine, chronic opioid dependency, pregnancyOpioid withdrawal, signs, symptomsClinical opioid withdrawal scale (COWS)Neonatal opioid withdrawal syndrome (NOWS)ComorbiditiesPhysical examinationInvestigationsToxicology screeningSmoking cessation interventionsAntepartum, intrapartum, postpartum managementOpioid agonists, buprenorphine, methadone, fetal biophysical parametersPerinatal risks, complications, maternal-fetal morbidity, adverse outcomeBreastfeeding
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 955 - 970
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

Committee on Obstetric Practice. Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017;130(2):e81–e94.CrossRefGoogle Scholar
Ecker, J, Abuhamad, A, Hill, W, et al. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol. 2019;221(1):B5–B28.CrossRefGoogle Scholar
Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. Geneva: World Health Organization; 2014.Google Scholar
Jones, HE, Kaltenbach, K, Heil, SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010;363(24):2320–2331.CrossRefGoogle ScholarPubMed
Kampman, K, Jarvis, M. American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015;9(5):358–367.CrossRefGoogle ScholarPubMed
Ordean, A, Wong, S, Graves, L. No. 349 – substance use in pregnancy. J Obstet Gynaecol Can. 2017;39(10):922–937.CrossRefGoogle ScholarPubMed
Reddy, UM, Davis, JM, Ren, Z, et al. Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017;130(1):10–28.CrossRefGoogle Scholar
Substance Abuse and Mental Health Services Administration. Clinical guidance for treating pregnant and parenting women with opioid use disorder and their infants. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.Google Scholar
The ASAM national practice guidelines for the use of medications to treat opioid use disorders 2015 with focused update 2020. Available at www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf. Accessed December 8, 2020.Google Scholar
Wright, TE, ed. Opioid Use Disorders in Pregnancy, Management Guidelines for Improving Outcomes. Cambridge: Cambridge University Press; 2018.Google Scholar

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