Abstract | March 24, 2024

Opioid Use Disorder (OUD) in Pregnancy: How OUD affects Peripartum Management and Obstetric Analgesics

Kennedi Wilson, MPH, Medical Student Year 4, University of Houston TJFF College of Medicine, Houston, TX;

Summer Chavez, DO, MPH, M.P.M., PPP/ Director of Department of Student Research, University of Houston TJFF College of Medicine, Houston, TX

Learning Objectives

  1. To further identify therapies and interventions, we must evaluate current protocols and treatment avenues for those who are pregnant with OUD, as presented by this piece of work

Introduction: Opioid use disorder (OUD) continues to increase in pregnant women, a population considered at high risk due to potential complications in labor and delivery as well as the lasting effects left on both the mother and neonates (Rizk et al, 2019). The prevalence of opioid substance use spiked by 127% in this population across a 14-year span and continues to escalate in the U.S. (Maeda et al, 2014). Pregnancies associated with OUD have worse outcomes in comparison to those without OUD; maternal death, maternal ACS events, preterm labor, stillbirth, and placental abruption are proven to have increased odds (Maeda et al, 2014).

Methods: In conducting the literature review, four databases for selected for the scoping review: Cochrane Library, PubMed, JSTOR and Academic Research Complete. Within each database search (MeSH) terms were identified and included in an advanced search. This yielded 143 resources all evaluated based on inclusion and exclusion criteria (directly answers research question, must be from year 2013 forward, must be conducted or contained in United States studies/ records, must include adult women only) then assessed for duplications and crossovers, leaving a total of 50 resources for the literature review analysis.

Results: The research brought forth main themes in peripartum management and obstetric analgesic care: (1) a multidimensional approach is optimal for success in addressing OUD in pregnancy (e.g. policy, interdisciplinary teams), (2) best practice management for OUD includes buprenorphine and methadone, (3) techniques for pain analgesics during labor and delivery for pregnant patients with OUD require both pharmacology and pain scale assessments, (4) access and affordability are necessary components to be evaluated for adequate care.

Conclusions: Understanding the effects on opioid use in antepartum, intrapartum, and postpartum on pain and labor management, as well as the ultimate effects on the neonate and maternal health is pivotal to drive patient centered care, reduce morbidity and mortality, and optimize best patient outcomes. Thematic analysis is still in progress with anticipated completion in December 2023.

References and Resources

  1. Reno JL, Kushelev M, Coffman JH, Prasad MR, Meyer AM, Carpenter KM, Palettas MS, Coffman JC. Post-Cesarean Delivery Analgesic Outcomes in Patients Maintained on Methadone and Buprenorphine: A Retrospective Investigation. J Pain Res. 2020 Dec 30;13:3513-3524. doi: 10.2147/JPR.S284874. PMID: 33408510; PMCID: PMC7779306.
  2. O’Connor AB, Smith J, O’Brien LM, Lamarche K, Byers N, Nichols SD. Peripartum and Postpartum Analgesia and Pain in Women Prescribed Buprenorphine for Opioid Use Disorder Who Deliver by Cesarean Section. Subst Abuse. 2022 Jun 21;16:11782218221107936. doi: 10.1177/11782218221107936. PMID: 35754980; PMCID: PMC9218889.
  3. Lim G, LaSorda KR, Krans E, Rosario BL, Wong CA, Caritis S. Associations between postpartum pain type, pain intensity and opioid use in patients with and without opioid use disorder: a cross-sectional study. Br J Anaesth. 2023 Jan;130(1):94-102. doi: 10.1016/j.bja.2022.09.029. Epub 2022 Nov 10. PMID: 36371258; PMCID: PMC9900726.
  4. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014 Dec;121(6):1158-65. doi: 10.1097/ALN.0000000000000472. PMID: 25405293.
  5. Rizk AH, Simonsen SE, Roberts L, Taylor-Swanson L, Lemoine JB, Smid M. Maternity Care for Pregnant Women with Opioid Use Disorder: A Review. J Midwifery Womens Health. 2019 Sep;64(5):532-544. doi: 10.1111/jmwh.13019. Epub 2019 Aug 12. Erratum in: J Midwifery Womens Health. 2020 Jan;65(1):176. PMID: 31407485; PMCID: PMC7675450.
  6. Jones HE, Deppen K, Hudak ML, Leffert L, McClelland C, Sahin L, Starer J, Terplan M, Thorp JM Jr, Walsh J, Creanga AA. Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. Am J Obstet Gynecol. 2014 Apr;210(4):302-310. doi: 10.1016/j.ajog.2013.10.010. Epub 2013 Oct 10. PMID: 24120973; PMCID: PMC7213596.
  7. Wong S, Ordean A, Kahan M; MATERNAL FETAL MEDICINE COMMITTEE; FAMILY PHYSICIANS ADVISORY COMMITTEE; MEDICO-LEGAL COMMITTEE; AD HOC REVIEWERS; SPECIAL CONTRIBUTORS. Substance use in pregnancy. J Obstet Gynaecol Can. 2011 Apr;33(4):367-384. doi: 10.1016/S1701-2163(16)34855-1. PMID: 21501542.
  8. Lim G, Soens M, Wanaselja A, Chyan A, Carvalho B, Landau R, George RB, Klem ML, Osmundson SS, Krans EE, Terplan M, Bateman BT. A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine. Anesth Analg. 2022 Nov 1;135(5):912-925. doi: 10.1213/ANE.0000000000006167. Epub 2022 Sep 22. PMID: 36135926; PMCID: PMC9588509.
  9. Harter K. Opioid use disorder in pregnancy. Ment Health Clin. 2019 Nov 27;9(6):359-372. doi: 10.9740/mhc.2019.11.359. PMID: 31857932; PMCID: PMC6881108.
  10. Martin CE, Almeida T, Thakkar B, Kimbrough T. Postpartum and addiction recovery of women in opioid use disorder treatment: A qualitative study. Subst Abus. 2022;43(1):389-396. doi: 10.1080/08897077.2021.1944954. Epub 2021 Jul 2. PMID: 34214405; PMCID: PMC8720325.
  11. Guille C, Simpson AN, Douglas E, Boyars L, Cristaldi K, McElligott J, Johnson D, Brady K. Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial. JAMA Netw Open. 2020 Jan 3;3(1):e1920177. doi: 10.1001/jamanetworkopen.2019.20177. PMID: 32003816; PMCID: PMC7042863.
  12. Höflich AS, Langer M, Jagsch R, Bäwert A, Winklbaur B, Fischer G, Unger A. Peripartum pain management in opioid dependent women. Eur J Pain. 2012 Apr;16(4):574-84. doi: 10.1016/j.ejpain.2011.08.008. PMID: 22396085; PMCID: PMC3290684.
  13. Rausgaard NLK, Ibsen IO, Jørgensen JS, Lamont RF, Ravn P. Management and monitoring of opioid use in pregnancy. Acta Obstet Gynecol Scand. 2020 Jan;99(1):7-15. doi: 10.1111/aogs.13677. Epub 2019 Jul 5. PMID: 31197827.
  14. Tobon AL, Habecker E, Forray A. Opioid Use in Pregnancy. Curr Psychiatry Rep. 2019 Nov 16;21(12):118. doi: 10.1007/s11920-019-1110-4. PMID: 31734808; PMCID: PMC10296780.
  15. Zedler BK, Mann AL, Kim MM, Amick HR, Joyce AR, Murrelle EL, Jones HE. Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child. Addiction. 2016 Dec;111(12):2115-2128. doi: 10.1111/add.13462. Epub 2016 Jun 30. PMID: 27223595; PMCID: PMC5129590.
  16. Klaman SL, Isaacs K, Leopold A, Perpich J, Hayashi S, Vender J, Campopiano M, Jones HE. Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance. J Addict Med. 2017 May/Jun;11(3):178-190. doi: 10.1097/ADM.0000000000000308. PMID: 28406856; PMCID: PMC5457836.
  17. O’Donnell FT, Jackson DL. Opioid Use Disorder and Pregnancy. Mo Med. 2017 May-Jun;114(3):181-186. PMID: 30228577; PMCID: PMC6140233.
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