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Understand the Idaho Pregnant and Perinatal Opioid Support System
Want to learn more about how Cornerstone Whole Healthcare Organization is supporting pregnant and postpartum women affected by opioid use disorder? Download our informative infographic for a visual overview of the Idaho Pregnant and Perinatal Opioid Support System (I-PPOSS).
This infographic highlights key components of I-PPOSS, including healthcare challenges, SUD in pregnancy statistics, project key initiatives, and our patient pathway.
Please share this infographic with your network to raise awareness about the challenges faced by pregnant and perinatal women with opioid use disorder.
It's Easy Naloxone Training
In this training video, clinical pharmacist Alice Knotts provides a clear and practical guide to using naloxone (Narcan) nasal spray to respond to opioid overdoses. You will learn what naloxone is, how it works to reverse the effects of opioid toxicity, and when it should be administered in an emergency. The video covers key signs of an opioid overdose, such as pinpoint pupils, unconsciousness, and irregular or absent breathing, and walks viewers through the simple step-by-step process of administering naloxone. You will also go over the importance of calling 911 and staying with the individual until help arrives, while also explaining the legal protections offered under Good Samaritan laws. The training is designed for anyone, from healthcare professionals to concerned community members, providing the tools needed to act quickly and confidently in a life-saving situation.
Printable Resources for Your Patients:
Understanding
Medications In Pregnancy
Depression in Pregnancy
Did you know that being depressed during pregnancy can affect your unborn baby? Many medications used to treat depression are considered safe to take in pregnancy.
Treating Opioid Use Disorder While Breastfeeding
Breastmilk has advantages for both the mother and baby. Both methadone and buprenorphine (Suboxone® or Subutex® ) are okay to take while breastfeeding.
Treating Opioid Use Disorder During Pregnancy
Opioid withdrawal during pregnancy increases the risk of return to opioid use without benefit to mother or baby.
Opioid Overdose in Pregnancy
If a pregnant woman is given naloxone and is dependent on opioids (that is, needs opioids to feel normal or good) giving naloxone may cause her unborn baby to start to stress.
Smoking During Pregnancy
When smoking, your body is exposed to more than 7,000 chemicals, including 70 that are known to cause cancer. These chemicals move from your lungs to your blood, leading to every organ in your body. When you smoke, it damages your body right away.
Alcohol Use During Pregnancy
Alcohol use during pregnancy is a considerable concern due to its capability to harm the developing fetus. Fetal Alcohol Spectrum Disorders (FASDs) are a range of conditions that can occur in an individual whose mother drank alcohol during pregnancy and can lead to lifelong physical, behavioral, and cognitive issues.
Keeping Medicine Safe at Home for Kids
Remember, medicine is not just what you are prescribed! Over the counter herbs, remedies for colds/pain are dangerous for children in high amounts!
Postpartum Medication Considerations
If you are on an antidepressant or depressed, talk to an OB provider or pharmacist about the benefits and risks of antidepressant treatment for depression during and after pregnancy.
SUD, Postpartum Depression, and Overdose Risk
Maternal mental health concerns can be caused by a combination of biological, psychological and social stressors.
Pregnancy Concerns with Common Drugs and Alcohol
Tobacco use during pregnancy poses significant health risks to both the mother and her unborn child. The severity of potential risk is impacted by the amount of tobacco exposure to the fetus. Smoking during pregnancy increases the risk of miscarriage, small gestational age, low birth weight, and stillbirth. It can also lead to birth defects and developmental problems.
Smoking can have negative effects on the mother’s health during pregnancy, increasing the risk of complications such as placental abruption (when the placenta separates from the uterus), placenta previa (when the placenta covers the cervix), and preeclampsia (dangerously high blood pressure during pregnancy).
Infants born to women who use smokeless tobacco during pregnancy have increased levels of nicotine exposure, higher rates of low birth weight, premature birth, stillbirth, and certain neonatal breathing disorders. These rates are as high as those in infants born to women who smoked cigarettes during pregnancy.
Exposure to secondhand smoke is also harmful during pregnancy and can lead to similar risks for the fetus as maternal smoking. Infants exposed to secondhand smoke are at increased risk of sudden infant death syndrome (SIDS).
Health organizations strongly advise pregnant women to avoid smoking and exposure to secondhand smoke. Quitting smoking at any point during pregnancy can significantly reduce the risks to the fetus and improve outcomes for both mother and child.
Because the risk to the fetus is impacted by the level of tobacco exposure, if a pregnant mother is unable to quit entirely, reducing the number of cigarettes smoked or treatment with nicotine replacement therapy can lower the risk to the infant.
Overall, quitting smoking is one of the most important steps a pregnant woman can take to protect her health and the health of her baby. Healthcare providers can play a crucial role in helping pregnant women quit smoking successfully.
Alcohol use during pregnancy is a considerable concern due to its capability to harm the developing fetus.
Fetal Alcohol Spectrum Disorders (FASDs) are a range of conditions that can occur in an individual whose mother drank alcohol during pregnancy and can lead to lifelong physical, behavioral, and cognitive issues. The most severe form is Fetal Alcohol Syndrome (FAS), which can cause abnormalities of the face, growth retardation, and nervous system problems.
The risk of alcohol use during pregnancy to the fetus depends on the amount of alcohol used, when during pregnancy it was consumed, and other risk factors like as genetics, overall health, and use of other harmful substances. Even small amounts of alcohol can pose risks particularly in the first and second trimesters when fetal organ development occurs.
Current clinical guidance recommends that pregnant women avoid alcohol entirely during pregnancy to prevent FASDs.
Using opioids during pregnancy can pose serious risks to both the mother and the unborn baby. Opioids, including prescription painkillers like oxycodone and hydrocodone, as well as illegal drugs like heroin, can lead to complications such as preterm birth, low birth weight, birth defects, and neonatal abstinence syndrome (NAS) in the baby. NAS occurs when a baby is exposed to opioids in the womb and experiences withdrawal symptoms after birth.
Pregnant individuals who are using opioids should seek medical help as soon as possible to ensure the safety of both themselves and their baby. Healthcare providers may recommend medication-assisted treatment (MAT) programs that involve the use of medications like methadone or buprenorphine to help manage opioid dependence during pregnancy. These programs are typically combined with counseling and support services to address the underlying issues of addiction.
It’s crucial for pregnant individuals who are struggling with opioid use to be open and honest with their healthcare providers so they can receive appropriate care and support throughout their pregnancy.
The effects of methamphetamine use on pregnancy and fetal development have been less well studied than those of opiates, alcohol, and cocaine. Available information indicates that methamphetamine use during pregnancy is consistently associated with a risk for premature birth and low birth weight. As is the risk of miscarriage and stillbirth, particularly when used in early pregnancy.
Methamphetamine use appears to be associated with neonatal and childhood neurodevelopmental abnormalities. This means methamphetamine crosses the placenta and affects the developing brain of the fetus. This can lead to long-term cognitive and behavioral issues for the child, including problems with attention, learning, and emotional regulation.
Pregnant women who use methamphetamines are at higher risk of high blood pressure, certain infections, and other complications during pregnancy and delivery. They may also have poor nutrition which, especially if paired with inadequate prenatal care, may endanger both their own health and the health of the baby.
Pregnant women struggling with methamphetamine use should seek immediate help from healthcare providers. Treatment may involve medical detoxification (under medical supervision), counseling, contingency management, support services, and possibly medication to address addiction and improve maternal and fetal health outcomes.
Smoking marijuana during pregnancy should be avoided. Cannabis smoke has many of the same toxins as tobacco smoke. Many times those concentrations are actually several times higher than tobacco smoke.
Cannabis use during pregnancy, including smoking and smokeless cannabis ingestion (edibles, vaping, etc), may disrupt fetal brain neurodevelopment. Children exposed to marijuana during pregnancy have lower scores on visual problem-solving tests, visual–motor coordination skills, and visual analysis exams.
Additionally, cannabis exposure during pregnancy is associated with childhood decreased attention span and behavioral problems and is an independent predictor of childhood marijuana use by 14 years of age.
Fetal exposure may lead to an increased sensitivity to other drugs of abuse. One significant concern is the use of cannabis and alcohol together. Cannabis can increase fetal brain susceptibility to the damaging effects of alcohol use in pregnancy.
Current evidence does not consistently indicate that cannabis use during pregnancy causes physical birth defects, preterm birth, or an increase in perinatal mortality.
There is some evidence to suggest a modest increase in the risk of stillbirth and lower birth weight, particularly if cannabis use occurs greater than or equal to weekly and/or if use occurs during the first and second trimesters.
For mothers, cocaine use during pregnancy can lead to high blood pressure, seizures, and increased risk of placental abruption (where the placenta separates from the uterus wall prematurely), which can be life-threatening for both the mother and the baby.
Cocaine use during pregnancy also increases the risk of premature delivery. Babies born to mothers who use cocaine are often smaller than those born to non-users. Children exposed to cocaine during pregnancy may experience developmental delays, behavioral problems, and learning difficulties later in life.
There is an increased risk of certain structural birth defects with cocaine use. However, the drug itself may or may not be a direct cause of these birth defects and many other factors may be involved.
Newborns whose mothers use cocaine during pregnancy may experience a complication at birth called Neonatal Withdrawal Syndrome which can be a medical emergency.
Maternal SUD: Common Myths and Misconceptions
MYTH: “If it’s an injectable medication, it must be better”
In pregnancy, transmucosal buprenorphine is a recommended treatment option, information related to other dosage forms in pregnancy is limited.
MISCONCEPTION: “Maternal SUD is too time-consuming and complex for primary care”
- For OUD, buprenorphine is a safe, lifesaving treatment for a common chronic disease.
- Initiations for Maternal OUD are generally recommended to be done under observation within an outpatient OB clinic or inpatient setting. However, this isn’t always an option, and primary care clinic and home inductions have been safely completed.
MISCONCEPTION: “Maternal SUD is the job of the OB doctor OR Maternal SUD is the job of the primary care provider (AKA Maternal SUD is not my job)”
The fact of the matter is, maternal SUD is everyone’s job. Whichever provider is in the right place at the right time and engages in the right conversation with the patient, should be able to take the steps needed to get them treatment for their SUD.
MISCONCEPTION: For OUD, wouldn’t it be best if the patient wasn’t on any opioid (illicit or treatment) while pregnant?
- Generally speaking, it is not recommended to detox during pregnancy.
- Opioid withdrawal during pregnancy increases the risk of return to opioid use disorder and overdose risk without benefit to mother or baby.
- Getting off opioid completely has an 88%-92% failure rate.
- When treated with the right medication, it reduces opioid craving and repeated episodes of fetal withdrawal which is harmful to the baby.
- When treated with the right medication, it reduces the likelihood of complications with fetal development, labor, and delivery.
MYTH: “If a woman uses a substance while pregnant, they are unfit to be a mother”
Addiction is a serious disease that is difficult to overcome even in the most motivating circumstances like pregnancy. Research shows that women who become pregnant are highly motivated to change their behaviors for the better for the sake of their unborn child’s health and development, but it’s not as easy as simply putting ones mind to it. During pregnancy, hormones cause a range of physiologic and psychological changes in one’s body and external factors like housing insecurity and negatively impactful relationships may influence a person’s ability to cope with these changes. A lack of understanding of consequences and lack of support system can also be contributing factors to an inability to completely stop use. What doesn’t this mean? This doesn’t mean they wouldn’t make a loving, caring, exceptionally fit mother. This does mean that they need all the support we can give them to help them on their journey toward recovery to help give them the best chance possible to keep their children.
MYTH: “Women with OUD on buprenorphine can’t receive analgesia during labor and delivery”
Patients on buprenorphine for OUD should continue their daily dose of buprenorphine AND receive the same pain management options during labor and delivery as other patients. Additionally, due to buprenorphine’s affinity for the mu receptor, use of potent opioids such as hydromorphone or fentanyl may be required to achieve adequate pain relief and should be considered and titrated to effect (this may be higher than for opiate-naive patients). Monitor patients for oversedation and somnolence. Partial opioid agonists like Stadol (butorphanol) should be avoided for the treatment of labor pain or preoperative sedation in buprenorphine patients due to the risk of triggering precipitated withdrawal. When possible, a multimodal approach to pain relief can maximize non-opioid use. (ACOG 2017; Krans 2019; SAMHSA 2021, UptoDate24). If additional pain relief is needed for post operative pain control following a c-section or complicated labor and delivery a Relapse Prevention Plan should be discussed with the patients with strategies such as – a caregiver handles, fills, and administers the medication as ordered, the patient does not touch the pill or bottle, patient does not count the pills, and after 24 hrs of not requiring opiate medications, caregiver disposes of left over medications. (Dively16)
Peer Support for Your Pregnant Patients
Peer Support Handout for Your Patients
Peer Support Specialists are people who have a substance use disorder, are in recovery, and are trained and certified to help people in similar situations through safe, non-judgmental recovery-focused support.
Share this flyer with your patients who may need peer support services while pregnant. They may also call the peer support line listed below.
Peer Support Line: (208) 812-4888
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