Purpose of the ReviewOpioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population.Recent FindingsWe review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal (“detoxification”) is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad.SummaryFurther research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.

Fetal growth restriction, or low birthweight is a strong determinant for eventual obesity and Type 2 diabetes. Clinical studies suggest placental mechanistic target of rapamycin (mTOR) signaling regulate fetal birthweight and the metabolic health trajectory of the offspring. In the current study, we used genetic model with loss of placental mTOR function (mTORKO Placenta ) to test the direct role of mTOR signaling on birthweight and the metabolic health in the adult offspring. mTORKO Placenta animals displayed reduced placental area and total weight, as well as fetal bodyweight at embryonic day (e) 17.5. Birthweight and serum insulin levels were reduced; however, β-cell mass was normal in mTORKO Placenta newborns. Adult mTORKO Placenta offspring, under a metabolic high-fat challenge, displayed exacerbated obesity and metabolic dysfunction compared to littermate controls. Subsequently, we tested whether enhancing placental mTOR complex 1 (mTORC1) signaling, via genetic ablation of TSC2, in utero would improve glucose homeostasis in the offspring. Indeed, increased placental mTORC1 conferred protection from a diet-induced obesity in the offspring. In conclusion, placental mTORC1 serves as a mechanistic link between placental function and programming of obesity and insulin resistance in the adult offspring.

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INTRODUCTION: Opioid use in pregnancy has increased dramatically, paralleling the epidemic observed in the general population. Many of these women have a history of sexual trauma. Our objective was to identify factors that adversely affect the labor and delivery experience for women with opioid use disorder and concomitant sexual trauma history. METHODS: This is a subgroup analysis of 13 women with a history of sexual trauma who participated in an opioid replacement therapy program during pregnancy. Participants underwent semi-structured qualitative interviews for a study about women with a history of sexual trauma. Interviews focused on the antenatal, intrapartum, and immediate post-partum experiences. RESULTS: Participants felt stigmatized by unfamiliar providers for their opioid use disorder and voiced desire for a childbirth experience unaffected by addiction, except when medically necessary. Most participants were concerned their opioid tolerance would lead to inadequate intrapartum pain management. Many felt they received less breastfeeding encouragement than women without opioid use disorder. Separation from infants for routine care or management of neonatal abstinence syndrome without adequate explanation concerned participants. In this situation, many feared they had lost custody, felt there was little institutional concern for maternal-infant bonding and reported guilt about the impact of addiction on the infant. CONCLUSION: Women with opioid use disorder and concomitant sexual trauma history report distrust of the medical system. Emphasizing established therapeutic relationships, ensuring clear communication regarding intrapartum pain control, promoting infant care in the post-partum room, and reinforcing legal determination of custody may improve labor and delivery experiences for this group of women.

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