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16
ASSESSMENT AND TREATMENT OF OPIOID USE
DISORDER IN PREGNANT WOMEN
Untreated opioid use disorder can pose significant risk for
pregnant women. It can lead to pregnancy complications as well
as miscarriage, premature delivery, fetal growth restriction, and
fetal death.
• Treatment for opioid use disorder should be initiated as early
in the pregnancy as possible.
» Ideally the patient would be seen by a clinician experienced
in pregnancy care as well as a clinician experienced
in addiction treatment. However, if a specialist is not
available, pregnant women should still seek prenatal care
and discuss their need for opioid use disorder treatment.
• The clinician should complete a medical evaluation to identify
any urgent medical issues that need to be addressed.
» Medical examination can include laboratory tests, physical
examination, ultrasound, and questions about the patient's
mental health and individual needs.
• The most important things that a pregnant woman with
opioid use disorder can do are to get regular prenatal care and
addiction treatment.
• Withdrawal can be dangerous during pregnancy. Patients
should work with their clinician to manage withdrawal if they
are going to stop or cut down on their opioid use (including
prescription opioid use).
• The clinician should talk to the patient about the risks and
benefits of the different treatment options. They should make
a decision together based on what is best for the patient.
• Methadone and buprenorphine are the best treatments
available for pregnant women with opioid use disorder. The
clinician may recommend that the patient be hospitalized
when the medication is started, especially in the third
trimester. However, for most patients these medications can
be safely started in an outpatient setting.
