In parallel with the opioid epidemic in the general population, opioid use and associated opioid use disorders in pregnancy are rising
According to an administrative database study,1 the number of infants born in Ontario to women given a diagnosis of opioid use disorder (including prescription and nonprescription opioids) increased 16-fold from 46 in 2002 to 761 in 2014.
Guidelines support universal screening for drug use, including opioids, by prenatal care providers
Screening based on perceived risk factors misses cases and perpetuates stigma and stereotyping.2,3 A validated screening tool should be used at first prenatal assessment and then periodically when clinically relevant (Box 1).2
Validated screening tools for prenatal opioid use disorder2
4 P’s for Substance Abuse: Parents, Partner, Past, Present)
National Institute on Drug Abuse (NIDA) Quick Screen
CRAFFT (Car, Relax, Alone, Forget, Friends and Trouble) questionnaire: substance abuse screen for adolescents and young adults (for women aged 26 years or younger)
Opioid-agonist therapy is the standard of care for opioid use disorders in pregnancy, alongside counselling and mental health supports2,3
The cycle of opioid withdrawal and intoxication in pregnancy, in addition to often coincident social instability, can be harmful to both mother and fetus. Pregnant women with an opioid use disorder should be offered timely access to opioid agonist therapy.2,3 Both methadone and buprenorphine-naloxone are safe in pregnancy.3 Care providers should familiarize themselves with local resources to ensure timely linkage to prenatal care, addiction counselling and social supports.
Neonatal opioid withdrawal syndrome is best managed by keeping mothers and infants together after delivery
Compared with care in the neonatal intensive care unit, rooming-in is associated with stronger mother–infant bonding, higher likelihood of breastfeeding, reduced pharmacologic treatment and shorter length of stay.4 Breastfeeding should be encouraged in women who are stable on opioid agonist therapy, for whom there are no concerns about ongoing drug use postpartum.2,3
Ongoing support in the postpartum period is essential
A recent study found that women with opioid use disorders are at increased risk of fatal overdose in the first year postpartum.5 Ongoing medical and social supports through primary care providers and opioid agonist therapy prescribers should remain stable postpartum to reduce this risk and support the well-being of mother and baby.2,5
Footnotes
Competing interests: None declared.
This article has been peer reviewed.