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Opioid Addiction in Pregnancy

Shainker, Scott A. DO, MS*; Saia, Kelley MD, BSN; Lee-Parritz, Aviva MD

Obstetrical & Gynecological Survey: December 2012 - Volume 67 - Issue 12 - p 816–824
doi: 10.1097/OGX.0b013e3182788e8c

The purpose of this review is to discuss the incidence, risks, pregnancy complications, and maintenance options for treatment of opioid addiction in pregnancy.

Summary: Opioid dependence in pregnancy carries clear identifiable maternal and fetal risk. Providing care for patients with dependence is best done in a multidisciplinary care model addressing the particular needs of this population. There are limited data on maternal detoxification, with data still emerging surrounding the safety profile of this practice. Historically, methadone has been the recommended maintenance treatment; however, recent data on buprenorphine identify this as a safe and effective option. The majority of births from women with opioid dependence result in neonatal abstinence syndrome requiring prolonged neonatal hospitalization. Intrapartum pain management should not differ from the general obstetric population. Postpartum pain is magnified in this population, and particular attention should be focused on this issue. Breast-feeding is recommended regardless of maintenance dose, unless other conditions restricting breast-feeding are present. Comprehensive postpartum care and transition of care to addiction specialists are highly recommended.

Target Audience: Obstetricians and gynecologists, family physicians, addiction specialists

Learning Objectives: After completing this CME activity, physicians should be better able to assess the treatment options available to patients with opioid addiction during pregnancy, compare the risk/safety profiles of methadone and buprenorphine, and evaluate the recommendations and current data surrounding breast-feeding while on opioid maintenance treatment.

*Adjunct Clinical Instructor, †Assistant Professor, Director Substance Abuse in Pregnancy Program, ‡Associate Professor, Vice Chair, Residency Program Director, Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston Medical Center.

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

The authors have disclosed that the US Food and Drug Administration has not approved the use of methadone or buprenorphine in pregnancy as discussed in this article. However, the use of both medications for the treatment of opioid addiction in pregnancy is the accepted standard of care. Please consult the products’ labeling for approved information.

Correspondence requests to: Scott A. Shainker, DO, MS, 85 E Concord St, Boston University School of Medicine, Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA 02118. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.