Opioid Use Disorder in Pregnancy

Of the roughly 84,000 pregnancies in the state of Missouri, about 8,400 (or 10%) are mothers who struggle with an alcohol or drug problem. One serious issue is opioid use disorder, also known as substance use disorder or opioid addiction, which is the use or abuse of heroin, fentanyl and prescription opioids. 

 
How does a woman know she is affected? 
The signs of opioid use disorder often include the need to increase drug usage to achieve the desired effect — whether it be pain relief or a high — or the presence of withdrawal symptoms when decreasing use, such as anxiety, nausea and tremors among many others. Other red flags might be neglecting family, work or social obligations or difficulty with relationships.

How does opioid use affect pregnancy?
Women who struggle with opioid dependence are more likely to have irregular menstrual cycles. Because of this, it may take longer for these women to realize they are pregnant and see an obstetrician. However, when most discover they are pregnant, it motivates them to seek treatment for the first time. Without treatment, they are more likely to have babies with birth defects, low birth weight, neonatal abstinence syndrome and many other dangerous complications. Fortunately, seeking treatment early can help reduce these risks.
 
How can it be treated?
Detox in pregnancy is not commonly recommended due to the risks of miscarriage or fetal distress and the high likelihood of relapse. For these reasons, medication-assisted treatment with methadone or buprenorphine is often preferred, as it safely and effectively decreases opioid use, resulting in good outcomes for moms and babies. 

Unfortunately, less than half of pregnant women who need treatment obtain it, as they may feel guilty or ashamed of their disease, or be afraid to tell their partner or family that they suffer from opioid use disorder. There is also the fear of legal ramifications or being deemed “unfit” to care for their newborn child — which very rarely happens if the mother complies with a treatment program. Our mission as a medical community and as obstetricians is to help identify these women, reassure them that help is available, and provide them with a safe, compassionate space that will allow them to have a healthy pregnancy and go home with a healthy, newborn baby.

Andrew Fisher, MD, is an OB-GYN at Contemporary Women’s Healthcare located on the Progress West Hospital campus. You can schedule an appointment with Dr. Fisher by calling 636.928.WELL.

Local resources for women with opioid use disorder include the Center for Life Solutions and the St. Louis Metro Treatment Center. Women can also call 1.800.662.HELP, a free helpline by the Substance Abuse and Mental Health Services Administration (SAMHSA).