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SCOPE

DISEASE/CONDITION(S)

In utero exposure to maternal illicit drugs and/or medication assisted treatment (MAT) with potential for neonatal abstinence syndrome.

GUIDELINE OBJECTIVE(S)

Review best practices for antenatal and postnatal care plans for both the substance exposed newborns and their families to assist in successful transition home.

BRIEF BACKGROUND

The well-documented epidemic of opioid use in the United States and internationally has resulted in a rising incidence of births by mothers with opioid use disorder (OUD). It is estimated that in the United States, one child is born each hour requiring treatment for neonatal abstinence syndrome (NAS). Complications of OUD in pregnancy include miscarriage, preterm labor, preterm premature rupture of membranes, intrauterine growth restriction, preeclampsia, and stillbirth. Accordingly, substance-exposed newborns (SENs) born to mothers with OUD are at increased risk of adverse health and social outcomes both short term (e.g., NAS) and long term (e.g., foster care placement, neurodevelopmental impairment). In the United States, the current incidence of NAS is 3−4 infants/1000 live births, though a significant variation is noted geographically. Mirroring this are increases in resources utilized, with an average NAS admission costing $53,400. The outcomes of substance-exposed pregnancies and infants depend on multiple factors including, but not limited to, socioeconomic factors/influences, co-occurring psychiatric disorders, family infrastructure, community support, the types of substances used, genetic and metabolic factors, treatment medications, feeding type and mode (breastfeeding vs breastmilk vs formula), parental education, and the degree of parental involvement in infant care. Efforts to improve neonatal outcomes must address multiple factors such as maternal sobriety, breastfeeding and bonding, and best practices for NAS treatment. To improve care of the SENs, the requisite interventions need to be implemented ideally in the preconception and antenatal period. Well thought out clinical care plans are also needed in the early neonatal period as well as in the long-term post-discharge follow-up care aimed at monitoring growth and neurodevelopmental outcomes.

RECOMMENDATIONS

RECOMMENDATION 1

Establishing a consistent preconception and antenatal care and counseling program for families affected by OUD is paramount. It is well known that women with chronic medical conditions will have greater success at conceiving and carrying a healthy pregnancy to term if there is good control of their preexisting conditions, such as obesity, diabetes, and hypertension. Therefore, it stands to reason that a mother enrolled in a structured rehabilitative program utilizing a MAT program prior to conception and during pregnancy will have a greater potential for achieving a healthy term pregnancy.

Practice Option #1

Females in childbearing age of 15−44 years who are in stable MAT programs should discuss pregnancy plans and contraception options with their primary care and obstetric providers. These discussions should be incorporated into routine annual as well as post conception visits. Attention should focus on standard pregnancy counseling as ...

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