Guideline No. 443b: Opioid Use Throughout Women’s Lifespan: Opioid Use in Pregnancy and Breastfeeding

To provide health care providers the best evidence on opioid use and women’s health. Areas of focus include pregnancy and postpartum care. The target population includes all women currently using or contemplating using opioids. Open, evidence-informed dialogue about opioid use will improve patient care. Exploring opioid use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Opioid use should not be stigmatized, as stigma leads to poor “partnered care” (i.e., the partnership between the patient and care provider). Health care providers need to understand the effect opioids can have on pregnant women and support them to make knowledgeable decisions about their health. A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome, and breastfeeding. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). All health care providers who care for pregnant and/or post-partum women and their newborns. Opioid use during pregnancy often co-occurs with mental health issues and is associated with adverse maternal, fetal, and neonatal outcomes; treatment of opioid use disorder with agonist therapy for pregnant women can be safe during pregnancy where the risks outnumber the benefits. 1.Opioids are highly addictive and often prescribed for pain relief and overprescribing has contributed to the opioid epidemic in Canada (high).2.Opioids should only be prescribed when absolutely necessary, in the lowest effective dose, and for the shortest duration necessary (high).3.Pregnant women who use illicit opioids are at increased risk of sexually transmitted infections, being victims of and/or participating in violence and other illegal activity, concurrent mental health disorders, polysubstance use, poor nutrition, and reliance on social assistance