Clinical care for opioid-using pregnant and postpartum women: The role of obstetric providers.

UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC 27510. Electronic address: .
American journal of obstetrics and gynecology (Impact Factor: 3.97). 10/2013; 210(4). DOI: 10.1016/j.ajog.2013.10.010
Source: PubMed

ABSTRACT We review clinical care issues related to illicit and therapeutic opioid use among pregnant and postpartum women, and outline the major responsibilities of obstetric providers who care for these patients during the antepartum, intrapartum, and postpartum periods.Selected patient management issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high quality obstetric care and in coordinating services with other specialists as needed. Obstetric providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment to patients with drug use disorders. Opioid-dependent pregnant women can often be effectively treated with methadone or buprenorphine. These medications are classified as pregnancy Category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label". Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged due to a high relapse rate. Acute pain management in this population deserves special consideration because opioid-using patients can be hypersensitive to pain and use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, opioid-using pregnant women do not require more intense medical care than other pregnant patients in order to ensure adequate management and best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for opioid-using pregnant and postpartum women.

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