Indicated Opioids in Pregnancy: Guidance on Providing Comprehensive Care

Abstract

In modern obstetric practice, providers will encounter patients for whom opioid use in pregnancy is reasonable or even necessary. A “one-size-fits-all” approach to the counseling and management of such patients is misguided. Understanding indications for ongoing opioid use in pregnancy is essential to patient-centered care. Specifically, recognition of the nuanced differences between opioid dependence and opioid use disorder is crucial for appropriate diagnosis, screening for common concurrent conditions, adequately counseling about individualized maternal and perinatal risks, and accurate documentation of diagnoses and medical decision-making. In this paper, we explore the current typical scenarios in which opioid use in pregnancy may be encountered, ongoing opioid prescribing should be considered, and provide a guide for the obstetric provider to navigate the antepartum, intrapartum, and postpartum periods.

Key Points

• Opioid use in pregnant and postpartum individuals is not rare.

• Obstetric providers may elect to assume opioid prescribing.

• Obstetric providers are positioned to optimize outcomes for the mother–infant dyad.

Keywords

opioid use disorder - opioid dependency - prenatal care - pain management

Note

The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Publication History

Received: 16 May 2021

Accepted: 04 October 2021

Article published online:
12 November 2021

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