Substance Abuse in Pregnancy

Substance use disorder (SUD) is considered by many obstetricians to be a problem best managed by other disciplines. However, it is inevitably our problem as well. All physicians have likely contributed to overprescribing habit-forming medications to women of childbearing age.1 Obstetrician-gynecologists are uniquely positioned to be champions for those affected by SUD as the structure of prenatal care lends itself to an intense time of engagement in medical care during which women are uniquely motivated to optimize their health.2 With the proper education and tools, obstetricians stand to be fully equipped to identify and treat SUD. SUD affects women disproportionately. A 2014 Substance Abuse andMental Health Services Administration (SAMHSA) report showed female treatment admissions for opioid pain relievers (as the primary substance of abuse) outnumber male admissions in all age categories.3 The rate of opioid use during pregnancy is ∼5.6 per 1000 live births,4 with one study reporting > 85% of pregnancies in women with opioid use disorder were unintended.5 Not only has opioid use disorder significantly impacted maternal and child health, but the financial impact to society is high as well. In 2009, the cost of neonatal abstinence syndrome alone was $720,000,000 which increased to $1.5 billion in 2015.4,6 Of that, ∼80% of cost is incurred by Medicaid systems. To optimize the care of pregnant women with SUD, it is important to understand it as a disease process independent of pregnancy. SUD is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Similar to other chronic diseases such as chronic hypertension, type II diabetes, and asthma, without treatment or engagement in recovery activities, SUD is progressive and can result in disability or premature death. Such chronic diseases, including SUD, carry similar hallmarks: they are treatable with medications and intervention, they are prone to relapse at a rate of