Opioid Use in Pregnancy: A Review

Importance: The use and misuse of opioids in pregnancy have been increasing and are a major public health issue. Opioid use in pregnancy and during lactation has been associated with increased maternal and neonatal morbidity and mortality. Objective: This review aims to summarize the existing literature and current recommendations for opioid use while pregnant or lactating. Evidence Acquisition: A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: "opioids,""opioid maintenance therapy,""opioid use disorder,""suboxone,""buprenorphine,""methadone,""medication for opioid use disorder,""fetal outcomes,""perinatal outcomes,""pregnancy,""lactation,"and "neonatal abstinence syndrome."Results: Available studies on opioid use in pregnancy and during lactation were reviewed and support association with increased odds of maternal death, placental insufficiency, cardiac arrest, preterm birth, neonatal intensive care unit admission, lowbirth weight, and small for gestational age infants. Studies were also reviewed on pharmacotherapy options in pregnancy and promising prenatal care models. Conclusion and Relevance: There is a critical need for research on the effects of opioid use and related pharmacotherapy options in pregnancy. Once the adverse perinatal effects of opioid exposure are identified andwellcharacterized, patient education, intervention, and antenatal surveillance can be developed to predict and mitigate its impact on maternal and fetal health. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After participating in this activity, the learner should be better able to propose patient counseling strategies regarding prenatal opioid use; explain patient assessment measures for opioid use during pregnancy; and discuss recommendations regarding opioid use while breastfeeding.