Maternity Care for Pregnant Women with Opioid Use Disorder: A Review

Abstract

Opioid misuse is a problem that is complex and widespread. Opioid misuse rates are rising across all US demographics, including among pregnant women. The opioid epidemic brings a unique set of challenges for maternity health care providers, ranging from ethical considerations to the complex health needs and risks for both woman and fetus. This article addresses care for pregnant women during the antepartum, intrapartum, and postpartum periods through the lens of the opioid epidemic, including screening and counseling, an interprofessional approach to prenatal care, legal considerations, and considerations for care during labor and birth and postpartum. Providers can be trained to identify at-risk women through the evidence-based process of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and connect them with the appropriate care to optimize outcomes. Women at moderate risk of opioid use disorder can be engaged in a brief conversation with their provider to discuss risks and enhance motivation for healthy behaviors. Women with risky opioid use can be given a warm referral to pharmacologic treatment programs, ideally comprehensive prenatal treatment programs where available (a warm referral is a term used when a provider, with the patient's permission, contacts another provider or another service him or herself rather than providing a phone number and referral number). Evidence regarding care for the pregnant woman with opioid use disorder and practical clinical recommendations are provided.

Patient-Centered Quality Measurement for Opioid Use Disorder: Development of a Taxonomy to Address Gaps in Research and Practice

“…The literature points to primary care and the patient-centered medical home as a framework for developing patient-centered models of OUD care coordination, likely due to primary care's increasing role in OUD treatment delivery 104 , 116 (see Supplemental Appendix A Table A5). Most of more than 50 proposed models in the literature use the medical home to coordinate primary care and specialty services according to patient preferences and context, including approach to buprenorphine initiation, opioid titration and tapering, chronic pain management, perioperative care, care transitions, management of co-occurring illnesses that impact OUD risk, and facilitation of care through referrals 99 , 117 – 124 . For example, referrals that include “warm handoffs” for OUD may benefit patients at high risk for adverse outcomes 117 , 118 , 125 .…”

Current Resources for Evidence‐Based Practice, March/April 2021

“…Additionally, many US midwives are experts in the group prenatal care model, which has been shown to be an effective modality for providing interprofessional care during pregnancy for women with substance use disorders as well as for providing interpersonal support from the group 14 . I suspect many midwives may feel unprepared for screening for substance use and next steps, like midwives in Australia, 15 but professional development opportunities are available, starting with excellent reviews in the Journal of Midwifery & Women's Health 16,17 . Although neonatal care is in the purview of pediatricians, midwives play an important role as patient advocates for patients to breastfeed and for the mother‐infant dyad to not be separated.…”

Using Electronic Health Record Data to Explore the Challenges of Opioid Prescribing: A Short Communication

“…Additionally, the Substance Use in Pregnancy Recovery Addiction Dependence Clinic (SUPeRAD), which is a specialty prenatal clinic which integrates maternal fetal medicine, addiction specialists, and resource management to address opioid use and addiction during pregnancy has provided much needed care for a previously marginalized patient population. The SUPeRAD Clinic efforts have fostered further collaboration across specialties and extended innovative approaches to care in rural and underserved parts of Utah 14 , yet another example of disparate groups within our health system coming together to share and analyze data for the common good. Similar to other health care institutions, UUH initially created an Opioid Taskforce to provide an internal network for coordination of programs and external efforts to interface with government and civil society amidst ongoing opioid concerns.…”