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
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Opioid use in pregnant and postpartum individuals is not rare.
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Obstetric providers may elect to assume opioid prescribing.
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Obstetric providers are positioned to optimize outcomes for the mother–infant dyad.
Keywords
opioid use disorder - opioid dependency - prenatal care - pain management
