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Hospital Care for Pregnant Persons With OUD Review
Joan Park1, Mishka Terplan2, Jessica Ratner1
1Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
American Journal of Medicine Open
|December 1, 2025
Summary
Opioid use disorder (OUD) in pregnant individuals requires compassionate care. Medications for opioid use disorder (MOUD), like methadone and buprenorphine, are safe and effective during pregnancy and postpartum.
Area of Science:
- Obstetrics and Gynecology
- Addiction Medicine
- Maternal-Fetal Medicine
Background:
- Opioid use disorder (OUD) is a growing concern in pregnant populations.
- Pregnant individuals with OUD encounter significant stigma and barriers to care.
- Healthcare providers are crucial in offering non-judgmental, harm-reduction-based treatment.
Purpose of the Study:
- To emphasize the importance of screening and treating pregnant individuals for OUD.
- To highlight the safety and efficacy of medications for opioid use disorder (MOUD) during pregnancy.
- To guide healthcare providers in managing OUD throughout pregnancy and postpartum.
Main Methods:
- Screening all pregnant individuals for OUD.
- Initiating or continuing MOUD (methadone, buprenorphine) during hospitalization.
- Adjusting MOUD dosages based on increased metabolism during pregnancy.
- Managing opioid withdrawal with MOUD and adjuvant medications.
- Providing family-centered discharge planning and postpartum support.
Main Results:
- MOUD, including methadone and buprenorphine, are safe and considered gold-standard treatments for OUD in pregnancy.
- Dosage adjustments for MOUD may be necessary due to altered pharmacokinetics in pregnancy.
- Aggressive management of opioid withdrawal is essential, potentially including full agonist opioids.
- Postpartum care is critical to prevent relapse and overdose, requiring comprehensive support services.
Conclusions:
- Universal screening and treatment of OUD in pregnant individuals are recommended.
- OUD management during pregnancy requires individualized MOUD titration and withdrawal management.
- Sustained, family-centered care into the postpartum period is vital for long-term recovery and well-being.
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