Confronting the undertreatment of opioid use disorder in pregnancy: From hesitation to action

Opioid use disorder (OUD) in pregnancy is a significant yet underrecognized chronic medical condition that can complicate pregnancy, negatively impacting maternal and fetal outcomes. Opioid overdose is now the leading cause of death in reproductive-aged females, rising in incidence by 81% from 2017 to 2020, with the highest risk for late-stage postpartum women (43 to 365 days after delivery).1 Additionally, several states have identified opioid-related overdose death as the leading cause of death in pregnancy.2 This is a complex issue requiring a multifaceted approach with patient-centered care at the heart of the solution. Concurrently, the prevalence of OUD is increasing, and pregnant individuals are not immune. Several statistics have shown an increasing rate of OUD in pregnancy, but these likely underestimate the problem as most data come from inpatient reporting. A 2016-2018 Medicaid study using both inpatient and outpatient records estimated OUD prevalence at 324 per 100,000 live births—double previous estimates.3 Despite increased rates of OUD in this vulnerable population, rates of treatment remain low.4-7 As in other chronic medical conditions, there are effective evidence-based treatments for OUD that are highly recommended by all clinical practice guidelines; however, OUD in pregnancy remains undertreated whether due to access barriers, lack of education and training, stigma, fear of harm, or all of the above. Here are 5 actionable recommendations to address this issue.