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Opioid Use in Pregnancy

Abstract

Purpose of Review

Perinatal opioid use is a major public health problem and is associated with a number of deleterious maternal and fetal effects. We review recent evidence of perinatal outcomes and treatment of opioid use disorder (OUD) during pregnancy.

Recent Findings

Opioid exposure in pregnancy is associated with multiple obstetric and neonatal adverse outcomes, with the most common being neonatal opioid withdrawal syndrome (NOWS). Treatment with buprenorphine or methadone is associated with NOWS, but neither medication appears to have significant adverse effects on early childhood development. Buprenorphine appears to be superior to methadone in terms of incidence and severity of NOWS in exposed infants. The long-term effects of opioid exposure in utero have been inconclusive, but recent longitudinal studies point to potential differences in brain morphology that may increase vulnerability to future stressors.

Summary

Maintenance therapy with methadone or buprenorphine remains the standard of care for pregnant women with OUD given its consistent superiority to placebo in terms of rates of illicit drug use and pregnancy outcomes. New non-pharmacologic management options for NOWS appear promising. Future research is needed to further evaluate the effects of opioid exposure in utero and determine the optimal delivery model for maintenance therapy.

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Correspondence to Ariadna Forray.

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Erin Habecker and Ariadna Forray each declare no potential conflicts of interest.

Amalia Londono Tobon is supported by NIMH T32 (MH MH018268-34), the Ariella Ritvo Foundation Grant.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Reproductive Psychiatry and Women's Health

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Tobon, A.L., Habecker, E. & Forray, A. Opioid Use in Pregnancy. Curr Psychiatry Rep 21, 118 (2019). https://doi.org/10.1007/s11920-019-1110-4

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Keywords

  • Pregnancy
  • Drug
  • Opioids
  • Opioid
  • Perinatal
  • Antenatal
  • Postpartum