22
Special Populations
Pregnant Women
Î NEW – The first priority in evaluating pregnant women for OUD should
be to identify emergent or urgent medical conditions that require
immediate referral for clinical evaluation.
Î Treatment with methadone or buprenorphine is recommended and
should be initiated as early as possible during pregnancy.
See the buprenorphine section for guidance on induction.
Î MAJOR REVISION – Pregnant women who are physically dependent on
opioids should receive treatment using methadone or buprenorphine
rather than withdrawal management or psychosocial treatment alone.
Î MAJOR REVISION – A medical examination and psychosocial
assessment are recommended when evaluating pregnant women for
OUD.
• However, completion of all assessments should not delay or preclude initiating
pharmacotherapy for OUD.
• If not completed before initiating treatment, assessments should be completed as
soon as possible thereafter.
Î Obstetricians, gynecologists, and other healthcare providers that care
for pregnant women should be alert to signs and symptoms of OUD.
• Pregnant women with OUD are more likely to seek prenatal care late in
pregnancy, miss appointments, experience poor weight gain, or exhibit signs of
withdrawal or intoxication.
Î MAJOR REVISION – The psychosocial needs of pregnant women being
treated for OUD should be assessed, and patients should be offered or
referred to psychosocial treatment based on their individual needs.
• A woman's decision to decline psychosocial treatment or the absence of available
psychosocial treatment should not preclude or delay pharmacological treatment,
with appropriate medication management, during pregnancy.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î Counseling and testing for HIV should be provided in accordance with
state law.
• Tests for hepatitis A, B and C and liver function are also suggested.
• TB screening and testing, if appropriate.
• Hepatitis A and B vaccination is recommended for those whose hepatitis serolog y
is negative.
