Opioids and Obstetrics: Substance use disorders in pregnancy

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On Wednesday, Jan. 27, Courtney Townsel, MD, MSc, and Marcela Smid, MD, MS, MA directed the course, “Pills, Pot and Powdery Substance: Practical Considerations for MFMs in Addressing Perinatal Substance Abuse.” The case-based session focused on the opioid epidemic and its relationship to obstetric management, emphasizing practical steps for peripartum pain management and drug testing in women with substance use disorders.

During the course, Townsel examined neonatal opioid withdrawal syndrome (NOWS) and discussed evidence-based treatment methods for opioid use disorder and NOWS in pregnancy and postpartum.

Rates of pregnancy complications due to opioid use disorder quadrupled from 1999 to 2014, according to data from Townsel’s presentation, which resulted in four times as many infants born with neonatal abstinence syndrome (NAS) in 2014 than in 1999.

Liberal prescribing habits in Medicaid and privately insured patients, Townsel said, majorly contributed to increasing opioid use and general dependence.

“We have to resolve to prescribe only what patients need. Try to reduce the number of pills leftover when prescribing. Know that a one-size-fits-all approach is typically wrong,” Townsel said.

A focus should also be placed on postpartum care. “We need to ensure a warm handoff for our patients. The postpartum period can be a trigger for relapse,” noting the high levels of stress and increased incidence of peripartum mood disorders in pregnant patients with substance use disorders.

“Medication-assisted treatment is life-saving,” Townsel said, “and it will reduce the risk of relapse and opioid overdose.” It is encouraged, according to Townsel, that patients maintain their medication-assisted treatment in pregnancy and beyond.

Townsel is an Assistant Professor of Obstetrics and Gynecology at the University of Michigan. Her research interests include health disparities, substance use disorders in pregnancy and translational research.