Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment

Kelley A Saia, Davida Schiff, Elisha M Wachman, Pooja Mehta, Annmarie Vilkins, Michelle Sia, Jordana Price, Tirah Samura, Justin DeAngelis, Clark V Jackson, Sawyer F Emmer, Daniel Shaw, Sarah Bagley, Kelley A Saia, Davida Schiff, Elisha M Wachman, Pooja Mehta, Annmarie Vilkins, Michelle Sia, Jordana Price, Tirah Samura, Justin DeAngelis, Clark V Jackson, Sawyer F Emmer, Daniel Shaw, Sarah Bagley

Abstract

Purpose of the review: Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population.

Recent findings: We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad.

Summary: Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.

Keywords: Breastfeeding; Mental health disorder; Naltrexone; Opioid agonist treatment; Opioid use disorder; Pregnancy; Trauma-informed care.

Conflict of interest statement

Kelley A. Saia, Davida Schiff, Elisha M. Wachman, Annmarie Vilkins, Michelle Sia, Jordana Price, Tirah Samura, Justin DeAngelis, Clark V. Jackson, Sawyer F. Emmer, and Daniel Shaw declare that they have no conflict of interest. Pooja Mehta and Sarah Bagley declare funding from the ASAM-Millennium Research Institute research fellowship award, unrelated to this work. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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