II. Epidemiology

  1. Unintended Pregnancy in 80% of cases
  2. Up to 25 to 35% do not return for postpartum visit

III. Management

  1. See Opioid Use Disorder
  2. Mandatory substance use reporting varies by U.S. state
  3. Opioid Agonists (e.g. Buprenorphine)
    1. Preferred over alternative of continued Opioid use (e.g. Heroin)
  4. Mood Disorder treatment
    1. See Antepartum Depression
    2. See Postpartum Depression
  5. Repeatedly screen for high risk conditions
    1. Intimate Partner Violence
    2. Sexually Transmitted Infection (including HIV Infection)
    3. Tuberculosis Screening
    4. Hepatitis B Screening
    5. Hepatitis C screening
    6. Food insecurity
    7. Homelessness
  6. Pregnancy monitoring
    1. Obtain dating Ultrasound (7 weeks), Fetal SurveyUltrasound (16 to 20 weeks) and third trimester Ultrasound for Fetal Growth
    2. Involve maternal fetal medicine Consultation as needed
    3. Ensure adequate access to nutrition
  7. Support Services
    1. Refer to social services and case management
    2. Consider residential treatment
    3. Family Home Visiting referral (e.g. NFP, HFA, MESCH) via local public health
    4. Review support plan for pregnancy, delivery and postpartum parenting
  8. Prepare for Delivery
    1. Develop a delivery plan including analgesia and Anesthesia
  9. Prepare for Neonatal Abstinence Syndrome
    1. May require extended stay following delivery
    2. Encourage early Breast Feeding and skin to skin contact (may shorten syndrome duration)
  10. Postpregnancy Contraception

IV. Complications

V. Associated Conditions

  1. Comorbid mental health disorder (in addition to Substance Abuse)

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