There are many factors that make opioid use in pregnancy a unique issue, requiring special understanding and careful treatment.39 Beyond the obvious—that you are treating two patients, the fetus and the mother—there are other considerations.
- These are by definition young patients whose appropriateness for chronic pain treatment and risk factors for abuse are different from older adults.
- Opioid withdrawal involves a number of possible serious prenatal consequences including preterm labor, abruption, and fetal demise.40
- Guilt and shame may create a situation whereby the patient downplays the seriousness of her opioid use. Providers may be misled into believing they are dealing with occasional use, when they are in fact dealing with an opioid-use disorder.41
- Metabolic changes may occur during pregnancy that reduce the effect, and thereby the dose, of opioids needed to prevent withdrawal.
- Neonatal abstinence syndrome (NAS) is common after prolonged opioid use, and is best treated when anticipated prior to delivery.42
- Buprenorphine and methadone are the drugs of choice for treating opioid-use disorder in pregnancy. Such treatments should be provided by professionals familiar with the special dosing considerations for this population. Methadone has been used successfully for decades, though it has a higher rate of NAS and opioid-related risks. Buprenorphine is safer for the mother and baby and may be the preferred treatment in selected women.