Caring for Pregnant and Parenting Women with Opioid Use Disorder

In parallel with the opioid overdose crisis in the US, rates of opioid use disorder (OUD) have increased during pregnancy. Untreated OUD is associated with poor maternal, perinatal, and neonatal outcomes, whereas people who receive evidence-based care with either methadone or buprenorphine have birth outcomes that are similar to people without OUD. Nonetheless, treatment, especially medication for opioid use disorder (MOUD), remains unavailable and underutilized during pregnancy. Postpartum, the year following delivery, is a critical and overlooked period as mood changes, medication discontinuation, and lapses in insurance coverage are common. People with OUD are overrepresented in maternal deaths, especially during the postpartum period, where opioid overdose is among the leading causes of mortality. Public health and public policy responses to OUD in pregnancy are increasingly misaligned as the growth of punitive policies defies evidence-based practice recommendations and harms pregnant and parenting people and their families.