Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017

Journal of Perinatology volume 40, pages 412–421 (2020)Cite this article

Subjects

Abstract

Objective

To describe obstetrician–gynecologists’ practices and attitudes related to opioid use among pregnant and postpartum women.

Study design

A 2017 cross-sectional survey assessed U.S. obstetrician–gynecologists’ (N = 462; response rate = 34%) practices (management) and attitudes (knowledge, preparedness, confidence, barriers, and resources needed) related to opioid use among pregnant and postpartum women. Modified Poisson regression determined adjusted prevalence ratios (aPR) for advising medication-assisted therapy (MAT) for pregnant women with opioid use disorder (OUD) by knowledge, confidence, and preparedness.

Results

Of respondents, 33% always or usually advised MAT to pregnant women with OUD. Confidence in treating pregnant women who use opioids (aPR: 1.3, 95% CI: 1.0–1.8) and knowledge that substance use services were covered under the Affordable Care Act (aPR: 1.4, 95% CI: 1.1–1.8) were associated with advising MAT.

Conclusion

Evidence suggests that efforts are needed to enhance physician confidence to manage pregnant and postpartum patients who use opioids, which may increase optimal care of this patient population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. Jama. 2012;307:1934–40.

    Article  CAS  Google Scholar 

  2. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014;121:1158–65.

    Article  Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  4. Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization - United States, 1999–2014. MMWR Morbidity Mortal Wkly Rep. 2018;67:845–9.

    Article  Google Scholar 

  5. Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014. Pediatrics. 2018;141:e20173520.

    Article  Google Scholar 

  6. American College of Obstetricians and Gynecologists. Committee opinion no. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017;130:e81–e94.

    Article  Google Scholar 

  7. Meyer M, Benvenuto A, Howard D, Johnston A, Plante D, Metayer J, et al. Development of a substance abuse program for opioid-dependent nonurban pregnant women improves outcome. J Addiction Med. 2012;6:124–30.

    Article  Google Scholar 

  8. Center for Substance Abuse Treatment. Medication-assisted treatment for opioid addicted in opioid treatment programs inservice training. HHS publication no. (SMA) 09-4341. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2008.

    Google Scholar 

  9. Jones HE, Martin PR, Heil SH, Stine SM, Kaltenbach K, Selby P, et al. Treatment of opioid dependent pregnant women: clinical and research issues. J Subst Abus Treat. 2008;35:245–59.

    Article  Google Scholar 

  10. American College of Obstetricians and Gynecologists. Committee opinion no. 670: immediate postpartum long-acting reversible contraception. Obstet Gynecol. 2016;128:e32–7.

    Article  Google Scholar 

  11. Centers for Disease Control and Prevention (CDC). Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. MMWR Morbidity Mortal Wkly Rep. 2011;60:878–83.

    Google Scholar 

  12. The American Academy of Pediatrics (AAP). Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.

    Article  Google Scholar 

  13. Wojnar‐Horton R, Kristensen J, Yapp P, Ilett K, Dusci L, Hackett L. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol. 1997;44:543–7.

    Article  Google Scholar 

  14. Reece-Stremtan S, Marinelli KA, Academy of Breastfeeding Medicine. ABM clinical protocol# 21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeed Med. 2015;10:135–41.

    Article  Google Scholar 

  15. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of the assessment and management of neonatal abstinence syndrome. Addiction Sci Clin Pract. 2014;9:19.

    Article  Google Scholar 

  16. Ko JY, Tong VT, Haight SC, Terplan M, Stark L, Snead C, et al. Obstetrician-gynecologists’ practices and attitudes on substance use screening during pregnancy. J Perinatol. 2019 (in press).

  17. Terplan M, Longinaker N, Appel L. Women-centered drug treatment services and need in the United States, 2002–2009. Am J Public Health. 2015;105:e50–4.

    Article  Google Scholar 

  18. Sigmon SC. The untapped potential of office-based buprenorphine treatment. JAMA Psychiatry. 2015;72:395–6.

    Article  Google Scholar 

  19. Byatt N, Straus J, Stopa A, Biebel K, Mittal L, Moore Simas TA. Massachusetts Child Psychiatry Access Program for Moms: utilization and quality assessment. Obstet Gynecol. 2018;132:345–53.

    Article  Google Scholar 

  20. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 423: motivational interviewing: a tool for behavioral change. Obstet Gynecol. 2009;113:243–6.

    Article  Google Scholar 

  21. O’Connor MJ, Whaley SE. Brief intervention for alcohol use by pregnant women. Am J Public Health. 2007;97:252–8.

    Article  Google Scholar 

  22. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol. 2005;105:991–8.

    Article  Google Scholar 

  23. Bowden JA, Oag DA, Smith KL, Miller CL. An integrated brief intervention to address smoking in pregnancy. Acta Obstetricia et gynecologica Scandinavica. 2010;89:496–504.

    Article  Google Scholar 

  24. Ferreira-Borges C. Effectiveness of a brief counseling and behavioral intervention for smoking cessation in pregnant women. Preventive Med. 2005;41:295–302.

    Article  Google Scholar 

  25. Farr SL, Hutchings YL, Ondersma SJ, Creanga AA. Brief interventions for illicit drug use among peripartum women. Am J Obstet Gynecol. 2014;211:336–43.

    Article  Google Scholar 

  26. Wright TE, Terplan M, Ondersma SJ, Boyce C, Yonkers K, Chang G, et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. Am J Obstet Gynecol. 2016;215:539–47.

    Article  Google Scholar 

  27. Goodman D. Improving access to maternity care for women with opioid use disorders: colocation of midwifery services at an addiction treatment program. J Midwifery Women’s Health. 2015;60:706–12.

    Article  Google Scholar 

  28. Kroelinger CD, Rice ME, Cox S, Hickner HR, Weber MK, Romero L, et al. State strategies to address opioid use disorder among pregnant and postpartum women and infants prenatally exposed to substances, including infants with neonatal abstinence syndrome. MMWR Morbidity Mortal Wkly Rep. 2019;68:777–83.

    Article  Google Scholar 

  29. Patrick SW, Buntin MB, Martin PR, Scott TA, Dupont W, Richards M, et al. Barriers to accessing treatment for pregnant women with opioid use disorder in Appalachian states. Subst Abus. 2018;9:1–7.

    Article  CAS  Google Scholar 

  30. Adams AS, Soumerai SB, Lomas J, Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999;11:187–92.

    Article  CAS  Google Scholar 

  31. Schiff DM, Nielsen T, Terplan M, Hood M, Bernson D, Diop H, et al. Fatal and nonfatal overdose among pregnant and postpartum women in Massachusetts. Obstet Gynecol. 2018;132:466–74.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the respondents of the survey for their time and participation.

Funding

This work was funded by a contract to the American College of Obstetricians and Gynecologists by the Centers for Disease Control and Prevention (CDC; #200-2015-M-63715). CS and JS were, in part, supported by UA6MC19010 and UA6MC31609 from the Maternal Child Health Bureau of the Health Resources and Services Administration.

Author information

Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-S107-2, Atlanta, GA, 30341, USA

    Jean Y. Ko & Sarah C. Haight

  2. United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA

    Jean Y. Ko

  3. Division of Congenital and Developmental Disorders, National Center for Birth Defects and Developmental Disorders, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA

    Van T. Tong

  4. Friends Research Institute, 1040 Park Ave Suite 103, Baltimore, MD, 21201, USA

    Mishka Terplan

  5. Research Department, American College of Obstetricians and Gynecologists (ACOG), 409 12th Street SW, Washington, DC, 20024, USA

    Carrie Snead

  6. Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA, 98195, USA

    Jay Schulkin

Authors
  1. Jean Y. Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Van T. Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah C. Haight
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mishka Terplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carrie Snead
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jay Schulkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean Y. Ko.

Ethics declarations

Conflict of interest

The findings and conclusions in this report are those of the authors and do not necessarily reflect the official position of the US Department of Health and Human Services, the US Public Health Service, the Centers for Disease Control and Prevention, HRSA, or the authors’ affiliated institutions. The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ko, J.Y., Tong, V.T., Haight, S.C. et al. Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017. J Perinatol 40, 412–421 (2020). https://doi.org/10.1038/s41372-019-0535-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0535-2

This article is cited by

Search

Advanced search

Quick links