CL Case Conference: Managing Substance Use and Agitation in Pregnancy

We present the case of a 29-year-old G1P0 female at 21 weeks of gestational age with stimulant use disorder, substance-induced psychosis, and agitation who is admitted to obstetrics and gynecology. During her hospitalization, consultation-liaison psychiatry plays an important role in managing her psychotropic regimen and determining appropriate safety precautions. Subject matter experts examine critical aspects of psychiatric care in pregnancy and liaising with obstetric services, including protocols for unit placement, suicide risk assessment, and medicolegal considerations such as involuntary commitment, medical decision-making capacity, and mandated reporting. Special attention is given to the management of agitation as an obstetric emergency, with detailed guidance on both nonpharmacologic and pharmacologic treatment strategies. We also discuss stimulant use disorder in pregnancy, including epidemiology, risk factors, potential treatment options, and barriers to receiving care.