Hospital Care for Pregnant Persons With OUD Review

Opioid use disorder is increasingly prevalent among pregnant persons. Hospitalists and general obstetricians are uniquely positioned to treat pregnant persons with OUD, who may not otherwise be engaged in care. Pregnant people with OUD face stigma, discrimination, and fear of losing custody of their children. Providers should offer supportive and nonjudgmental care that is guided by the principles of harm reduction. All pregnant persons should be screened for OUD, diagnosed and treated accordingly. Medications for opioid use disorder (MOUD), methadone and buprenorphine, are safe in pregnancy and are gold standard treatment. Patients should be initiated or continued on MOUD during hospitalization. Pregnancy may increase metabolism of both buprenorphine and methadone, and therefore, dosages may need to be increased or given more frequently. Given the increase of high potency synthetic opioids, such as fentanyl, providers should be familiar with low-dose buprenorphine initiation or rapid methadone titration. Providers should monitor for opioid withdrawal and treat aggressively with MOUD and adjuvant medications. This may also require full agonists opioids. OUD treatment and support should continue into the post-partum period, a time of increased vulnerabilities to return to use, OUD recurrence, and overdose. Discharge planning should be family-centered, considering partners, their family, and the newborn. Social work and peer navigators should be engaged to help coordinate long-term outpatient resources including postpartum psychosocial support services such as substance use disorder treatment and relapse prevention programs.