Pregnancy and Substance Use Disorder

Pregnancy and Substance Use Disorder

Neonatal Withdrawal Syndrome (NWS) Services for our Communities Neonatal Withdrawal Syndrome (NAS) is a group of side effects that can occur when an infant is exposed to certain substances while in the womb. These substances can include things like caffeine, tobacco, certain medications, herbal remedies, and supplements. When a baby is used to being supplied with substances like these while in the womb, withdrawal can occur after the baby is born.

Key Points

  • Buprenorphine and methadone are safe and effective during pregnancy and breastfeeding. Both are recommended for treatment for opioid use disorder by ACOG.
  • Admission to the hospital or fetal monitoring regardless of gestational age is not required to start buprenorphine or methadone.
  • A positive urine drug test does not diagnose a substance use disorder and ACOG requires patient consent.
  • Neonatal abstinence syndrome (NAS)/neonatal opiate withdrawal syndrome (NOWS) is a potential side effect of medications for opioid use disorder, independent of dose. Rooming-in and breastfeeding help decrease NAS/NOWS.
  • Patient preference and shared decision making is paramount in developing treatment plans for opioid use disorder.

Building Trust with a Pregnant Patient with Substance Use Disorder

  • Listen and Prioritize Goals: Start by listening to the patient and understanding their goals.
  • Offer Treatment Options: Provide choices for treatment, such as methadone or buprenorphine, and discuss different ways to engage in treatment (home, clinic-based, or inpatient).
  • Use Trauma-Informed Care: Assume the patient has a history of trauma and be mindful that simple interactions can be triggering.
  • Counseling Strategies:
    • Focus on the patient's strengths.
    • Acknowledge that substance use disorders are chronic and relapsing.
    • Welcome patients back if they return to use or fall out of care.
    • Explore parenting goals without making assumptions.
    • Discuss prior CPS involvement and patient concerns nonjudgmentally.
  • Normalize the Condition and treat it as part of routine care.

Buprenorphine vs. Methadone for Pregnant Patients with Opioid Use Disorder

  • Patient Preference: The choice between buprenorphine and methadone should be based on what the patient prefers.
  • Safety and Effectiveness: Both medications are safe and effective.
  • Stability: If the patient is already stable on one medication, it's best not to switch to avoid withdrawal and relapse.
  • Provider's Role: Inform patients about their options and support them in making decisions that best meet their needs.
  • Practical Considerations:
    • Methadone: Requires daily clinic visits initially but has higher retention rates.
    • Buprenorphine: Causes less severe neonatal abstinence syndrome and may be more convenient for some patients.
    • Access: Consider the location of the nearest clinic or provider.
    • Neonatal Withdrawal: Discuss the risk of neonatal withdrawal after birth.
    • Engagement: Focus on what will keep the patient engaged in their treatment plan.

More detailed treatment information is available from CA Bridge.

Resources for Patients