Clinical Scorecard: Strategies for Managing Opioid Use Disorder in Pregnant Individuals: A Scoping Review
At a Glance
Category
Detail
Condition
Opioid Use Disorder (OUD) during pregnancy
Key Mechanisms
Medication for opioid use disorder (MOUD) combined with behavioral therapies and community/societal interventions
Target Population
Pregnant individuals with opioid use disorder in the United States
Care Setting
Prenatal clinical care, interpersonal support settings, community and societal levels
Key Highlights
MOUD adherence reduces maternal overdose risk and improves maternal and infant health outcomes.
Interventions span individual (clinical care, detoxification, education), interpersonal (clinician education, group therapy), and community/societal levels (service coordination, policy impact).
Community-based and societal interventions addressing social determinants and policy barriers may have the greatest impact on maternal health outcomes.
Guideline-Based Recommendations
Diagnosis
Identify OUD during pregnancy through screening in prenatal care settings.
Management
Implement evidence-based MOUD (buprenorphine or methadone) combined with behavioral therapies.
Provide coordinated clinical care models and prenatal education.
Incorporate clinician education and group therapy at the interpersonal level.
Support regional coordination of services and policy changes to improve MOUD access.
Monitoring & Follow-up
Monitor adherence to MOUD and engagement with behavioral therapies throughout pregnancy.
Assess social and financial support needs to foster mother-infant wellness beyond pregnancy.
Risks
Barriers to MOUD access and long-term adherence remain significant challenges.
Non-prescription substance use postpartum is common, especially with prenatal stressful life events.
Patient & Prescribing Data
Pregnant people with opioid use disorder, predominantly non-Hispanic white participants in many studies.
MOUD access and adherence are critical; interventions must address social determinants and systemic barriers to improve outcomes.
Clinical Best Practices
Use pregnancy as an opportunity to initiate and maintain MOUD and behavioral therapies.
Employ multi-level interventions addressing individual, interpersonal, community, and societal factors.
Integrate education for clinicians and patients to improve treatment uptake and retention.
Coordinate services regionally to enhance access and continuity of care.
Advocate for policy changes that reduce barriers to MOUD during pregnancy.
by Amanda L. Elmore, Mirine Richey, Dewan S. Tahsin, Gabriella Hinks, William Velez-Jimenez, Allison M. Howard, Tanner Wright, Anthony Kendle, Cheryl Vamos
