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Am J Obstet Gynecol. 2014 Apr;210(4):302-310. doi: 10.1016/j.ajog.2013.10.010. Epub 2013 Oct 10.

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

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UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. Electronic address:
Department of Family Medicine, Grant Medical Center, Columbus, OH.
Department of Pediatrics, University of Florida College of Medicine-Jacksonville, FL.
Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA.
UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC.
Pediatric and Maternal Health Staff, Maternal Health Team, Office of New Drugs, Food and Drug Administration, Silver Spring, MD.
Addiction Recovery Program, Brigham and Women's Faulkner Hospital, Boston, MA.
Department of Obstetrics, Gynecology & Reproductive Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Addiction Recovery Service, Swedish Medical Center, Seattle, WA.
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.


We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment 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. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively 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 because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period.


opioid use; opioid-agonist; substance use

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