2026-2027 | Live Session | Pregnancy and Women's SUD: Focus on OUD Treatment Strategies | August 2026-Pregnancy and Women's SUD: Focus on OUD Treatment Strategies Presentation

Pregnancy and Women's SUD: Focus on OUD Treatment Strategies Presentation

Pdf Summary

This presentation reviewed evidence-based treatment of substance use disorders in pregnancy, with a focus on opioid use disorder (OUD). It emphasized that overdose is now the leading cause of maternal death in the U.S., and that the prenatal and postpartum periods are critical intervention windows.<br /><br />Key clinical points included:<br />- Pregnancy changes drug pharmacokinetics, often requiring higher or split doses of medications for opioid use disorder (MOUD), especially in the third trimester.<br />- For OUD, the goal is to treat the disorder, not manage withdrawal. Methadone and buprenorphine are both appropriate; buprenorphine is often preferred, and buprenorphine/naloxone is considered safe in pregnancy.<br />- Fentanyl complicates buprenorphine initiation, so several initiation strategies were reviewed: standard induction, high-dose/macro induction, low-dose initiation (LDI), direct-to-inject extended-release buprenorphine, and methadone.<br />- If precipitated withdrawal occurs, it should be treated aggressively, often with more buprenorphine plus supportive medications.<br />- Methadone dosing may need to rise and be split in pregnancy; postpartum, MOUD should generally be continued rather than reflexively tapered.<br /><br />The talk also covered other substances:<br />- Alcohol withdrawal in pregnancy is an emergency and should be managed inpatient.<br />- Benzodiazepines should not be abruptly stopped.<br />- Nicotine cessation should be actively treated.<br />- Cannabis and stimulant use were discussed, along with adulterants like xylazine and medetomidine.<br /><br />For newborns, the presentation recommended Eat, Sleep, Console (ESC) as first-line management for neonatal opioid withdrawal syndrome (NOWS), with escalation to pharmacotherapy only when needed. Nonpharmacologic care—especially rooming-in, breastfeeding, and skin-to-skin contact—was emphasized as foundational.<br /><br />Finally, the presentation stressed universal verbal screening, careful and non-punitive drug testing, honest discussion about mandatory reporting, and strong postpartum planning to reduce relapse and overdose risk.

Keywords

pregnancy

opioid use disorder

medication for opioid use disorder

methadone

buprenorphine

fentanyl

neonatal opioid withdrawal syndrome

Eat Sleep Console

postpartum care

substance use treatment