No. 349-Substance Use in Pregnancy

To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers. This guideline reviews the use of screening tools, general approach to care, and recommendations for the clinical management of problematic substance use in pregnancy. Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation. Updates in the literature were retrieved through searches of Medline, PubMed, and The Cochrane Library published from 1996 to 2016 using the following key words: pregnancy, electronic cigarettes, tobacco use cessation products, buprenorphine, and methadone. Results were initially restricted to systematic reviews and RCTs/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report. This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care lead to reduced health care costs and decreased maternal and neonatal morbidity and mortality. 1.All pregnant women and women of child-bearing age should be asked periodically about alcohol, tobacco, prescription, and illicit drug use (III-A).2.When testing for substance use is clinically indicated, urine drug screening is the preferred method (II-2A). Informed consent should be obtained from the woman before maternal drug toxicology testing is ordered (III-B).3.Policies and legal requirements with respect to drug testing of newborns may vary by jurisdiction, and caregivers should be familiar with the regulations in their region (III-A).4.Health care providers should employ a flexible and harm reduction approach to the care of pregnant women who use alcohol, tobacco, or drugs. Pregnant women at risk for problematic substance use should be offered brief interventions and referral to community resources for further psych