Pregnancy and Women's SUD: Focus on OUD Treatment Strategies (2025-2026 Recording)-Pregnancy and Women's SUD: Focus on OUD Treatment Strategies Recording

Video Transcription

Video Summary

Dr. Tipu Khan delivered a comprehensive lecture on opioid use disorder (OUD) in pregnancy, while also reviewing alcohol, benzodiazepine, nicotine, vaping, and cannabis use. He emphasized that pregnancy involves a mother-infant dyad, so treatment must address both maternal health and fetal development, with attention to stigma, trauma, and social instability.

Key points included:
- <strong>Screening</strong> for substance use is recommended at the first prenatal visit and again each trimester if risk factors persist.
- <strong>Medication treatment for OUD (MOUD)</strong> with <strong>methadone or buprenorphine</strong> is preferred over withdrawal/detoxification, which can increase relapse and fetal risk.
- <strong>Buprenorphine and methadone are both effective</strong>, but buprenorphine may lead to less severe neonatal opioid withdrawal and shorter infant hospital stays.
- <strong>Dose changes in pregnancy</strong> are often needed, especially for methadone in the third trimester; doses should generally <strong>not be reduced immediately after delivery</strong>.
- <strong>High-dose fentanyl</strong> may require newer induction strategies, including <strong>microinduction, rapid induction, macroinduction, IV buprenorphine, and direct-to-inject long-acting buprenorphine</strong>. Where treatment is started depends on patient stability and support: home, clinic, residential care, or hospital.
- He reviewed management of <strong>precipitated withdrawal</strong>, pain control during labor and postpartum, and the importance of a prewritten birth plan.
- <strong>Breastfeeding is usually encouraged</strong> with methadone or buprenorphine, and is generally compatible with many other medications, with specific cautions for codeine, illicit stimulants, and certain situations involving HIV or hepatitis C.

Overall, he stressed compassionate, evidence-based, patient-centered care to improve outcomes for both parent and infant.

Keywords

opioid use disorder

pregnancy

methadone

buprenorphine

medication treatment

neonatal opioid withdrawal

substance use screening

fentanyl induction

precipitated withdrawal

breastfeeding

maternal fetal health

patient-centered care