Policy calls for public health approach to opioid misuse by pregnant women
CarlaKemp, Senior Editor
The use of prescription opioids by pregnant women has surged in the last decade, leading
to a nearly fivefold increase in newborns experiencing withdrawal, studies have shown.
Some states have considered responding by prosecuting and incarcerating pregnant women
with substance use disorders. However, this punitive approach has no proven benefits
and may harm both women and their babies, according to a new policy statement from
the AAP Committee on Substance Use and Prevention.
Instead, the policy recommends a public health response to this epidemic that focuses
on preventing unintended pregnancies, universal substance use screening for women
of childbearing age, improved access to opioid replacement therapy for pregnant women
and more funding for child welfare systems.
The policy, A Public Health Response to Opioid Use in Pregnancy, is available at http://bit.ly/2kjFEoh and will be published in the March issue of Pediatrics.
One infant is born every 25 minutes with neonatal abstinence syndrome (NAS), according
to a study cited in the policy. The diagnosis of NAS may be missed due to the vagueness
of signs and delayed presentation, leading to poor outcomes.
Therefore, it is vital for pediatricians to be aware of substance use during pregnancy
so they can provide effective care for infants, including those with NAS, the policy
The Academy first published a policy on drug-exposed infants in 1990, which called
for nonpunitive access to comprehensive care for pregnant women who abuse substances
and their infants. Since then, more than 20 national groups have gone on the record
against prosecution and punishment of pregnant women who use illegal drugs. However,
many states are considering or have passed laws that allow women to be criminally
prosecuted if their substance use during pregnancy harms their babies.
The policy notes that such laws may deter women from getting prenatal care and agreeing
to drug testing. Instead, it calls for a public health approach grounded in science
and makes the following recommendations:
Primary prevention: The public should be educated about the addictive potential of prescription opioids
to prevent their misuse before pregnancy. Access to reproductive health services,
including long-acting reversible contraception, should be expanded.
Identification: All women should be screened for substance use at routine health care visits and several
times during prenatal care, regardless of age, race, ethnicity or socioeconomic status.
Informed consent should be obtained from pregnant women before urine drug testing
is performed. The woman should be aware of who will have access to the results and
how positive results will be used for treatment and reporting to child welfare agencies.
Access to treatment: Access to comprehensive prenatal care and treatment should be improved for pregnant
women with substance use disorders, including medication-assisted treatment and gender-specific
substance use treatment programs that provide nonjudgmental, trauma-informed services.
Criminal justice approaches: Health care providers who care for pregnant women should know if their state requires
illicit drug use to be reported and educate women prenatally about these requirements.
States should clarify which substances must be reported and define the health care
provider’s role in reporting.
Child welfare systems: More funding is needed for social support services and child welfare systems to ensure
the safety of substance-exposed infants and provide optimal care to families.