The rate of opioid use disorder (OUD) among pregnant women more than quadrupled from 1999 to 2014.1 Since the rate of opioid overdose has skyrocketed in recent years, treating pregnant women with OUD calls for a well-informed approach to patient safety—and an understanding of how pregnancy presents a unique opportunity for treatment.
During pregnancy, opioid use presents distinct risks—but pregnancy can be a turning point for women experiencing OUD. Though it is a stressful time, it can also be a time of motivation to change. When treating pregnant women and their infants, physicians should consider the following six essential steps:
These six essential steps are derived from the following Opioids Stewardship Checklist, which offers a set of general principles for patient safety with opioids.
To prevent new opioid starts, the CDC has issued a set of guidelines:
To manage pain safely and prevent opioid starts, physicians should consider the Enhanced Recovery After Surgery bundle,5 which includes the routine use of nonsedating pain treatments such as nonopioid drugs and regional anesthesia. Postoperative pain management using an ERAS protocol was studied in patients with open gynecological surgery and was found to reduce mean opioid consumption by 72 percent without differences in pain scores.
By keeping in mind the Opioids Stewardship Checklist and following the six essential steps when treating pregnant or parenting mothers suffering from OUD, physicians can move from stigma to science, improving outcomes for mothers and infants.
Hannah Snyder, MD, practices primary care and addiction medicine at Zuckerberg San Francisco General Hospital, is a clinical assistant professor at UCSF, and is the director of Project SHOUT (Support for Hospital Opioid Use Treatment).Christine Pecci, MD, practices family medicine at Zuckerberg San Francisco General Hospital and is a clinical professor with UCSF. These opinions are of the authors and not associated with any of these organizations.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.