Opioid misuse in pregnancy

Abstract

Key content The UK has one of the highest rates of opioid misuse in Europe, with dramatic escalation over the last decade. Much of this drug use in women coincides with childbearing age and continues into pregnancy. Opioid misuse in pregnancy is associated with considerable obstetric and neonatal complications. Management of women with opioid misuse in pregnancy requires a multidisciplinary approach with specialist input from drug services. Opioid substitution regimes with methadone or buprenorphine during pregnancy have been shown to improve perinatal outcomes and the woman’s compliance with care. Learning objectives To be familiar with the obstetric and neonatal complications that can arise from opioid misuse in pregnancy; in particular, neonatal abstinence syndrome. To appreciate the wider needs of women who misuse opioid medication and how we can support them during the antenatal, intrapartum and postpartum periods. To understand how opioid substitution regimes with methadone or buprenorphine can lead to an improvement in pregnancy and infant outcomes. Ethical issues While opioid substitution regimes reduce illicit drug use, improve compliance with obstetric care and improve neonatal birthweight, women should be counselled that they do not eliminate the risk of neonatal abstinence syndrome. Should we be commencing opioid‐dependent women on long‐term contraception prior to discharge to avoid potential future unplanned pregnancies? What safeguarding issues need to be addressed for the pregnant mother, unborn child and other existing children?