Medication-Assisted Treatment For Opioid Use Disorder In Pregnancy: Practical Applications And Clinical Impact

ImportanceOpioid use disorder is increasingly common in the United States and affects many pregnancies. Given the rise in pregnancies complicated by opioid use, providers should understand the diagnosis and management of opioid use disorder in pregnancy.ObjectiveThis article focuses on screening for opioid misuse, selecting appropriate treatment for patients, initiating medication-assisted treatment in the inpatient setting, and providing appropriate peripartum care.Evidence AcquisitionA PubMed search was undertaken using the following search terms: "opioid use disorder", "pregnancy," "medication assisted treatment," "buprenorphine," "methadone," "heroin," "addiction," "neonatal abstinence syndrome," and "detoxification." The search was limited to the English language publications, with most being published after 2000.ResultsAll women should be screened for opioid use disorder during pregnancy. Opioid use has profound effects on the mother and infant. Medication-assisted treatment is the standard of care for pregnant women with opioid use disorder. Patients will require a multidisciplinary approach to management in the intrapartum and postpartum period.ConclusionsOpioid use disorder is a common, chronic condition with significant implications during pregnancy. Recognition and appropriate treatment of this disorder can optimize maternal and fetal outcomes.RelevanceObstetricians are increasingly being challenged to manage pregnancies complicated by opioid use disorder and should be proficient in providing safe and effective care.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to describe the effects of opioid use disorder on the mother-infant dyad during the antepartum, intrapartum, and postpartum periods; assess why medication-assisted treatment remains the standard of care for pregnant women with opioid use disorder; and explain the risks and benefits of different types of medication-assisted treatment and illustrate specific medication-assisted treatment initiation protocols.