Should pregnant women with substance use disorders be managed differently?

Abstract

Summary Pregnant women with substance use disorders have multiple special needs, which might be best managed within a multiprofessional treatment setting involving medical, psychological and social care. Adequate treatment provision remains a challenge for healthcare professionals, who should undergo special training and education when working with this patient population. Careful assessment and screening is necessary to tailor interventions individually to the woman's needs in order to achieve beneficial clinical outcomes for mothers and newborns, whereas the choice of treatment options highly depends on the type of substance of abuse and evidence-based treatment interventions available. Economic considerations have shown that early multiprofessional treatment might yield better clinical outcomes and save healthcare costs over the lifespan.

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

“…Relapse rates are high and repeated cycles of intoxication and withdrawal are associated with significant fetal distress that can lead to placental insufficiency and consequent pregnancy loss, intrauterine growth restriction (IUGR) and preterm labor and birth 5, 7, 8, 9. The accepted treatment for OUD during pregnancy is long‐acting opioid agonist medication‐assisted treatment (OMAT), such as methadone (MET) or buprenorphine (BUP), within the context of a comprehensive program of obstetric care and psychosocial interventions 5, 8, 10, 11, 12, 13, 14. Adequate medication treatment maintains stable opioid blood levels that reduce maternal craving for and use of heroin or other opioids and improves prenatal care and fetal/infant outcomes compared with untreated opioid use or opioid withdrawal 11, 15, 16.…”

Schwangerenbetreuung bei Drogenkonsum

“…Die Feststellung der Schwangerschaft bedeutet für die betroff ene Frau oft einen zusätzlichen Belastungsaspekt in einer ohnehin instabilen Lebenssituation. Nicht unterschätzt werden dürfen dabei die Schuld-und Schamgefühle der Schwangeren, sowie die Angst vor fetaler Fehlbildung durch den Drogenkonsum [ 27 ] . Für die geburtshilfl iche Betreuung kommt erschwerend hinzu, dass es sich meist um ungeplante und erst nach dem ersten Trimenon bemerkte Schwangerschaften handelt.…”

“…Trimenon unabdingbar [ 40 ] . Arbeiten, die die Infektionsprävalenzen speziell bei schwangeren Drogenkonsumentinnen untersuchten, zeigten eine große Streubreite in den Resultaten, jedoch mit ebenfalls hohen Erkrankungszahlen [ 27 ] . Frühgeburtsbestrebungen können durch regelmäßige Messungen der sonografi schen Cervixlänge rechtzeitig erkannt werden.…”

A Unique Opportunity to Study Short- and Long-Term Consequences in Children Prenatally Exposed to Illicit Drugs and Opioid Maintenance Treatment Using Czech and Scandinavian Registers

“…The treatment initiation and adherence in pregnant illicit drug users are complicated by factors related to both the patients and the treatment providers, such as delays in treatment referral, fear of adverse effects of treatment and stigmatization due to illicit drug use (17).…”