ACOG Statement on Opioid Use During Pregnancy

Washington, DC—Mark S. DeFrancesco, MD, MBA, President of the American College of Obstetricians and Gynecologists (ACOG), released the following statement regarding the U.S. Centers for Disease Control and Prevention opioid guidelines:

"The American College of Obstetricians and Gynecologists thanks the U.S. Centers for Disease Control and Prevention (CDC) for providing guidelines for physicians on prescribing opioid medications to patients. ACOG and its Fellows have long recognized the growing, tragic problem of opioid addiction in the United States and appreciates CDC's focus on this important public health issue.

"ACOG agrees with the CDC that opioids should only be used for treatment of pain when alternatives are not appropriate or effective, but we also know that there are times, including during pregnancy and the postpartum period, when such use is both appropriate and safer than the alternative. Opioids may be needed to treat acute pain such as from cesarean delivery, kidney stones, sickle cell crisis or trauma in pregnancy, or as part of an established plan to treat problems associated with substance use disorders.

"ACOG provided comments to the CDC to help ensure that their clinical guidelines for providers accurately reflected best practice surrounding opioid use in pregnancy. However, we are concerned that some of the CDC's patient education communications regarding use of opioids during pregnancy could discourage women from needed, appropriate care by overstating the risk of rare complications associated with opioid use during pregnancy and by understating the potential risk associated with opioid discontinuation.

"To assure optimal health outcomes for both a woman and her baby, for example, it is recommended that patients and providers continue opioid agonist treatment in pregnancy. Neonatal abstinence syndrome is the most established risk to newborns from use of opioids in pregnancy, but it is expected and treatable, and does not appear to pose permanent risks to the neonate. However, evidence shows that withdrawal from opioid use during pregnancy may be associated with complications including fetal demise. While some studies have suggested an association between birth defects and other adverse outcomes with opioid use in pregnancy, the absolute risk of these problems is low and data demonstrating a causal connection are lacking. As a result, there are circumstances in which the balance of risk and benefits argues for judicious use of these medications in pregnancy, either for pain management or opioid agonist treatment.

"ACOG hopes that CDC's new information regarding opioid use helps to address and mitigate the ongoing opioid crisis in our country. However, we continue to advocate for an evidence-based approach to opioid use during pregnancy that supports the ability of pregnant women to access appropriate care.

"To that end, ACOG has convened an Opioids and Addiction Medicine Expert Work Group comprising ob-gyns with expertise in opioid addiction, substance abuse and evidence-based medicine. In addition, on April 29, ACOG will host two courses, provided by the American Society of Addiction Medicine (ASAM), regarding opioid use. The buprenorphine course will train ob-gyns to obtain a waiver to engage in office-based treatment of opioid use disorders using drugs approved by the FDA on Schedules III, IV, and V. This buprenorphine course will be unique in that it will include special emphasis on women and opioid addiction as well as pregnancy and buprenorphine use. There will also be an opioid prescribing course as part of the training. Both courses will be available as a webinar in order to provide important education remotely."

Additional resources are below:

Resources for Providers

Opioid Use, Dependency, and Addiction in Pregnancy (Committee Opinion No. 524, May 2012, Reaffirmed 2014)

Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice (Committee Opinion No. 633, June 2015)

Guidelines for Perinatal Care, 7th Edition (2012, page 127-130)

Resources for Women and Families

Tobacco, Alcohol, Drugs, and Pregnancy (FAQ 170, December 2013)

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine (ASAM Pamphlet)

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 58,000 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. www.acog.org