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Opioid Use Disorder: Approach to Intrapartum and Postpartum Management

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Abstract

Purpose of Review

The care of pregnant people with opioid use disorder (OUD) presents unique challenges that have escalated with the opioid epidemic in the USA. The pregnancy-related mortality attributable to OUD, as well as the increased contact with the healthcare system during pregnancy, make the opportunities for intervention and engagement in care in the intra- and postpartum period critical, particularly given that the birth hospitalization is an almost universal experience. We aim to summarize an evidence-based approach for intra- and postpartum care and to review the important controversies that remain.

Recent Findings

The pregnancy-related mortality attributable to substance use, mostly OUD, is astounding at around 40% in many studies, and maternal mortality reviews have identified the postpartum period as being a particularly vulnerable time. In order to save lives, universal screening for substance use should be implemented using evidence-based approaches like SBIRT, and, when appropriate, medications for OUD (MOUD) should be offered. Trauma-informed multidisciplinary care and multimodal pain control remain cornerstones of the intrapartum period, while close follow-up and connection to resources are important in the postpartum period. The role of urine toxicology testing in pregnancy, opioid detoxification in pregnancy, and breastfeeding for patients in early recovery with ongoing illicit use remain controversial topics.

Summary

While we have made progress in understanding the gravity of the problem and the challenges of caring for perinatal patients with OUD, devising impactful clinical solutions is limited by (1) the even greater challenges of recruiting and retaining birthing people with OUD in prospective research studies and (2) the social and environmental factors outside of the medical system that make the lives of many of these patients so hard. Any long-lasting solutions extend beyond the medical profession and require policy change and societal engagement.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, UC Davis School of Medicine, 4860 Y St, Suite 2500, Sacramento, CA, 95817, USA

    Leanna S. Sudhof

  2. Department of Obstetrics, Gynecology and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Sarah N. Bernstein

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L.S. and S.N.B. wrote the main manuscript text. L.S. prepared Fig. 1, which was reviewed and edited by S.N.B.

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Correspondence to Leanna S. Sudhof.

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Sudhof, L., Bernstein, S.N. Opioid Use Disorder: Approach to Intrapartum and Postpartum Management. Curr Obstet Gynecol Rep 12, 199–208 (2023). https://doi.org/10.1007/s13669-023-00371-w

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