A Public Health Response to Opioid Use in Pregnancy

Abstract

The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefi ts for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical, including the following: a focus on preventing unintended pregnancies and improving access to contraception; universal screening for alcohol and other drug use in women of childbearing age; knowledge and informed consent of maternal drug testing and reporting practices; improved access to comprehensive obstetric care, including opioidreplacement therapy; gender-specifi c substance use treatment programs; and improved funding for social services and child welfare systems. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool (December 2016).

Prevalence of alcohol use in pregnant women with substance use disorder

“…Routine universal screening by validated screening questionnaires for alcohol and tobacco use, followed by brief intervention and referral to treatment is recommended by the ACOG (Committee on Obstetric Practice, 2017) and American Academy of Family Physicians (Wilkes, 2016). ACOG (American Congress of Obstetricians and Gynecologists, 2008), American Academy of Pediatrics (Patrick and Schiff, 2017), and American Nurses Association (American Nurses Association Center for Ethics and Human Rights, 2017) recommend that screening should be applied to all women equally, regardless of age, race, ethnicity, or socioeconomic status, while emphasizing a non-punitive approach towards pregnant women with SUD. Future studies should examine in greater detail the patterns of drinking among pregnant women with OUD and the role of other co-exposures (e.g., amphetamines and tobacco) on alcohol consumption and pregnancy outcomes, as well as examine effectiveness of early screening and brief interventions to minimize alcohol use in women with OUD.…”

Children in the Opioid Epidemic: Addressing the Next Generation’s Public Health Crisis

“…This is true for both women who are pregnant and parents who are involved with child welfare, among whom research reveals that MAT is associated with improved birth outcomes and child safety, respectively. 1,5 MAT also increases engagement in obstetric care, which may facilitate access to family planning and prevent further unwanted pregnancies. Providers should review safe storage practices with patients and may consider the presence of children in the household when determining dosage and the frequency of follow-up visits to avoid accidental ingestion by children.…”

Child Abuse, Incarceration, and Decisions About Life-sustaining Treatment

“…Efforts should be focused on encouraging high-quality prenatal care and treatment resources and support for pregnant mothers who use illicit substances rather than instilling fear of legal ramifications. 16 2. Despite the inherent conflict of interest, it is standard of care to allow parents to retain medical decision-making rights after charges of harm and/or abuse.…”