Pregnancy and Opiate Use Disorders

Pregnancy and Opiate Use Disorders

Opioid use disorder in pregnancy has increased by 300% between 1994 and 2014 and is up to over

six and a half cases per 1000 pregnant women in the United States (O’Rourke-Suchoff et al., 2020). As

there has been extra interest in opioid use disorder treatment with the growing epidemic there has also

been increased interest and research into the best and most effective treatment for pregnant individuals

who also have an opioid use disorder. Clinical guidelines indicate that the pregnant patient should either

continue or be placed on opioid maintenance medications methadone or buprenorphine to mitigate

withdrawal or illicit use (Ecker et al., 2019). Both medications are FDA approved for opioid use, and are

considered the gold standard for treatment of women who are pregnant and also struggling with an

obstetric, and newborn morbidity and mortality, fewer pregnancy complications, decreased HIV risk

behaviors as well as improved adherence to prenatal care (Ecker et al., 2019).

When transitioning a patient from an illicit opiate to MAT s, the Clinical Opiate Withdrawal Scale

(COWS) is used to determine if the patient is in withdrawal and will need additional medication for

cravings and stabilization (Gordon & Uquillas, 2021). This evidence-based scale is important to make

sure that the patient is on the smallest effective dose, but also very important for buprenorphine

induction as the patient must be in moderate withdrawal before receiving buprenorphine or risk

precipitated withdrawal if not yet in moderate withdrawal(Ecker et al., 2019)

A medication which is FDA-approved to help individuals who struggle with opioids but is not

indicated for pregnant women who are struggling with opiate use disorder in the United States is

precipitated withdrawal, spontaneous abortion, or preterm birth, and risk of relapse during the period

of abstinence before starting the medication (Ecker et al., 2019). While more research is needed to

clarify the safest way to transition a pregnant woman to naltrexone, keeping a pregnant woman already

stabilized on naltrexone seems to be an option that could provide some success vs the recommended

methadone or buprenorphine treatment.

While social support, psychotherapy, and resource support are recommended in all cases of the

pregnant woman struggling with opioid addiction, a third option that relies less on consistent

medication-assisted treatment is to undergo a detox process and rely solely on psycho-behavioral

interventions to remain sober. This is not typically recommended as it is more associated with a higher

rate of relapse, HIV risk behavior, infant and mother mortality, and morbidity (Ecker et al., 2019). If the

detox method is chosen, then one study found that the most effective variant is to have a woman

baby healthy outcomes (O’Rourke-Suchoff et al., 2020).

pregnant women. The psychiatric nurse practitioner must counsel other providers to put away any

judgment, bias, or negative feelings and work with the patient to find a treatment program that will set

them up for the greatest success. Psycho-social intervention, psychotherapy, and social support are

critical in supporting the substance use addicted pregnant woman and should be a focus of care. The

golden standard for opioid use treatment in this special population is medication assistant treatment

with either buprenorphine or methadone, and continued MAT post-pregnancy (Ecker et al., 2019). A

supportive practitioner should listen to the patient’s goals, and review their past treatment, if the

patient is already stabilized and substance-free with naltrexone, then that should be considered in the

continued treatment of an opioid use disorder. If the patient is against MAT, then the patient should be

counseled towards inpatient detoxification and an increase in support through a residential treatment

program, with outpatient follow-up and potential MAT initiation post-pregnancy.

Gynecology, 221(1), B5–B28. https://doi.org/10.1016/j.ajog.2019.03.022

Gordon, B., & Uquillas, K. (2021). 877 inpatient buprenorphine induction for opioid use disorder in

pregnancy. American Journal of Obstetrics and Gynecology, 224(2), S544–S545.

https://doi.org/10.1016/j.ajog.2020.12.900

Lappen, J. R., Stark, S., Bailit, J. L., & Gibson, K. S. (2020). Delivery dose of methadone, but not

buprenorphine, is associated with the risk and severity of neonatal opiate withdrawal syndrome.

American Journal of Obstetrics & Gynecology MFM, 2(1), 100075.

https://doi.org/10.1016/j.ajogmf.2019.100075

O’Rourke-Suchoff, D., Sobel, L., Holland, E., Perkins, R., Saia, K., & Bell, S. (2020). The labor and birth

experience of women with opioid use disorder: A qualitative study. Women and Birth, 33(6), 592–597.

https://doi.org/10.1016/j.wombi.2020.01.006

Wachman, E. M., Saia, K., Miller, M., Valle, E., Shrestha, H., Carter, G., Werler, M., & Jones, H. (2019).

Naltrexone treatment for pregnant women with opioid use disorder compared with matched

buprenorphine control subjects. Clinical Therapeutics, 41(9), 1681–1689.

https://doi.org/10.1016/j.clinthera.2019.07.003

Willey, A. S., Pilliod, R. A., Skeith, A. E., & Caughey, A. B. (2018). 217: Opiate detoxification in pregnancy:

A cost-effectiveness analysis. American Journal of Obstetrics and Gynecology, 218(1), S143.