Opioid Abuse During Pregnancy Spurs Medical Treatment Guidance

April 23, 2012

Washington, DC -- To maximize outcomes for mothers and infants, the health care of pregnant women addicted to opioid-containing prescription medications or heroin is best co-managed by ob-gyns and physicians specializing in addiction medicine, according to a Committee Opinion issued jointly today by The American College of Obstetricians and Gynecologists (The College) and the American Society of Addiction Medicine (ASAM). 

National data show that an estimated 4 percent of pregnant women reported using illegal drugs in the previous month. Other studies show that the rate of pregnant women using any type of opioid drug ranges from 0.1 percent to 2.6 percent. Chronic untreated opioid use during pregnancy greatly increases the risk of fetal growth restriction, placental abruption, preterm labor, and fetal death. Conversely, opioid withdrawal without treatment also raises the risk of fetal death.  

Screening for alcohol and substance abuse, as well as prescription medication use/abuse, should be routine before and during pregnancy, according to The College/ASAM recommendations. Methadone and buprenorphine are the only drugs approved for the treatment of opioid dependence. Both medications have risks and benefits and must be administered through either a certified methadone program or by physicians with specific credentials. The College/ASAM recommend against medically supervised withdrawal from heroin or other opioid drugs during pregnancy because of the high relapse rate and the increased risk of fetal distress and death.  

Committee Opinion #524 “Opioid Abuse, Dependence, and Addiction in Pregnancy” is published in the May issue of Obstetrics & Gynecology

Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #523 “Re-entering the Practice of Obstetrics and Gynecology” (NEW)
ABSTRACT: Re-entering the practice of obstetrics and gynecology after a period of inactivity can pose a number of obstacles for a physician. Preparing for the leave of absence may help reduce the difficulties physicians may face upon re-entering practice.

Committee Opinion #526 “Standardization of Practice to Improve Outcomes” (NEW)
ABSTRACT: Protocols and checklists have been shown to improve patient safety through standardization and communication. Standardization of practice to improve quality outcomes is an important tool in achieving the shared vision of patients and their health care providers.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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