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opioid (opiate) abuse in pregnancy

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  • opioid misuse in pregnancy
    • pregnant women who misuse opioids have an increased chance for pregnancy related problems
      • include poor growth of the baby, stillbirth, premature delivery, and the need for C-section
      • some women who misuse opioids also have unhealthy lifestyles that can result in health problems for both the mother and the baby
        • for example, poor diet choices can lead to mothers not having enough nutrients to support a healthy pregnancy and could increase the chance of miscarriage and premature birth; sharing needles to inject opioids increases the risk of getting diseases like hepatitis C and/or HIV which can also infect the baby
  • opioid treatment in pregnancy
    • maintenance, at a dose that stops or minimises illicit use, is most appropriate for ensuring continuity of management of pregnancy and aftercare
    • methadone in pregnancy
      • many mothers request detoxification, although during the first trimester the patient should normally be stabilised as there is an increased risk of spontaneous abortion
      • detoxification in the second trimester may be undertaken in small frequent reductions - for example 2-3 mg methadone every 3-5 days - as long as illicit opiate use is not continuing
        • if illicit opiate use continues, strenuous efforts should be made to stabilise the patient on a prescribed opioid, which may involve increasing its dose
        • further detoxification should not generally be undertaken in the third trimester because there is evidence that maternal withdrawal, even if mild, is associated with fetal stress, fetal distress, and even stillbirth. However, for some, slow, carefully monitored reductions may safely be continued as long as there are no obstetric complications or resumption of illicit drug misuse
      • metabolism of methadone is increased in the third trimester of pregnancy and it may occasionally be necessary to increase the dose or split it, from once-daily consumption to twice-daily consumption, or both
      • methadone has been used safely for many years but buprenorphine is not licensed for use with pregnant women
    • buprenorphine in pregnancy
      • research evidence demonstrates no adverse effects on the pregnancy or neonatal outcomes, with incidence of neonatal abstinence syndrome similar to methadone exposure
        • ".. in a pregnant woman who is stable on buprenorphine and informed of the risks it is reasonable to leave her on a prescribed dose of buprenorphine, rather than transfer to methadone with the risk of inducing withdrawal in the fetus.." (1)
        • if detoxification is unsuccessful and the patient's drug use becomes uncontrolled at any stage of pregnancy, reduction should be stopped or the opioid dose increased until stability is regained.

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Last edited 05/2020 and last reviewed 05/2020

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