Opioid Dependence and Pregnancy: Minimizing Stress on the Fetal Brain

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(Am J Obstet Gynecol. 2017;216(3):226–231)A 127% increase in women presenting for delivery who were opioid-dependent occurred between 1998 and 2011. This is associated with increased risk for comorbid medical conditions and mortality. The US Government Accountability Office published a report identifying gaps in knowledge concerning the care of women and neonates at risk for neonatal abstinence syndrome (NAS). There are 3 situations in which chronic opioid use and/or exposure occurs: pain management, active untreated opioid use disorder (OUD) and OUD treated with methadone or buprenorphine. Each situation should be treated differently when assessing effects on neonates. This paper, informed by published research and clinical practice in a methadone/buprenorphine treatment program including a specialized pregnancy program, reviewed these different types of opioid dependence in pregnant women and identified areas in which more research is needed.

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