The CDC has recently published guidelines for opioid use in chronic pain to address the growing concerns surrounding risks and safety of chronic opioid use. These concerns include opioid use disorder, overdose, and death. The use of opioids is common in pregnancy due to chronic and acute pain and the need for pain medications following delivery. ACOG asserts that there are times during pregnancy and the postpartum period when the use of opioids is appropriate, and they expressed concern that the CDC's patient education communications may overstate the risk and result in women being discouraged from appropriate use during pregnancy.
Of particular concern to OB/GYNs is that the withdrawal of opioids during pregnancy has been associated with pregnancy complications including fetal demise. Currently, the biggest risk of continued opioid use during pregnancy is considered to be neonatal abstinence syndrome, which is not associated with long-term sequelae.
ACOG has convened an Opioids and Addiction Medicine Expert Work Group to examine this issue further. Pregnant women who are at risk for complications of opioid use should be referred to a high-risk (MFM) OB provider. An ACOG buprenorphine course and an opioid prescribing course will be available as a webinar on April 29 to provide further information.
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