(Obstet Gynecol. 2015;126:474–478)
Opioid-dependent pregnant women who undergo acute opioid withdrawal during pregnancy are at increased risk for miscarriage, placental abruption, preterm labor, and stillbirth. Physicians should thus have basic familiarity with the medical, ethical, and legal issues surrounding opioid maintenance therapy, which mitigates the risks of frequent withdrawal during gestation and reduces the risk of relapse after delivery. Longer-lasting therapies like methadone and buprenorphine can increase accessibility to care for this population all while preserving confidentiality, decreasing social stigma, and reducing lengthy resource-intensive hospitalizations. Other benefits include lowered risk of bloodborne infection transmission and improved maternal and neonatal health outcomes.