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Guidance for Opioid Use Disorder in Pregnancy

Obstet Gynecol; ePub 2017 Aug; Mascola, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion on opioid use and opioid use disorder in pregnancy that stresses the importance of early screening, conducting a brief patient intervention, and referral for treatment of pregnant women with opioid use and opioid use disorder to improve maternal and infant outcomes. Among the other recommendations and conclusions from the ACOG:

  • Screening for substance use should be part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman.
  • For pregnant women with an opioid use disorder, opioid agonist pharmacotherapy is the recommended therapy.
  • Infants born to women who used opioids during pregnancy should be monitored by a pediatric care provider for neonatal abstinence syndrome.
  • Health care providers will need to modify some elements of prenatal care in pregnant women with an opioid use disorder in order to meet the clinical needs of the patient’s particular situation.
  • Before prescribing opioids, obstetrician-gynecologists and other health care providers should ensure that opioids are appropriately indicated.
  • Breastfeeding should be encouraged in women who are stable on their opioid agonists, who are not using illicit drugs, and who have no other contraindications.
  • Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to minimize the risk of unplanned pregnancy.

Citation:

Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e81–94.