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AAP Urges Public Health Approach For Women Who Use Opioids During Pregnancy

2/20/2017
Punitive approach has not been shown to be effective and may deter women from seeking help

As the number of pregnant women who use opioids has increased over the past decade, more infants have been born experiencing withdrawal symptoms, a national trend that requires a public health response rather than a punitive approach, according to a new policy statement released by the American Academy of Pediatrics (AAP).

While some state governments have prosecuted and jailed the mothers for substance use, the punitive measures provide no proven health benefits for mother or child -- and may lead to avoidance of prenatal care and substance use treatment, according to the report. The policy statement, “A Public Health Response to Opioid Use in Pregnancy,” will be published in the March 2017 issue of Pediatrics (online Feb. 20).

“Over the last two decades, use of opioids surged throughout the U.S., and as they did, we have seen an increase in opioid-related complications in nearly every population, including pregnant women and their infants,” said Stephen Patrick, MD, MPH, MS, FAAP, a co-author of the report.

“Our response should be grounded in public health. We should be bolstering efforts targeted at primary prevention, like prescription drug-monitoring programs, and expanding treatment tailored to the specific needs of pregnant women and their families.”

The rate of infants born experiencing withdrawal symptoms, a condition known as neonatal abstinence syndrome, has grown nearly fivefold over the last decade, and, by 2012, accounted for an estimated $1.5 billion in hospital charges, according to research. In 2012, one infant was born every 25 minutes with the condition nationwide – prompting attention from the public, providers and policymakers.

Besides improving access to contraceptives, prenatal care and treatment for substance use disorder, the Academy recommends:

  • Universal routine screening for alcohol and other drug use in women of childbearing age
  • Providing information and obtaining informed consent for maternal drug testing and reporting practices
  • Improved access to comprehensive obstetric care, including opioid-replacement therapy
  • Substance treatment programs specifically designed for pregnant women
  • Improved funding for social services and child welfare systems
Access to comprehensive prenatal care and treatment for women with substance use disorders is associated with fewer preterm deliveries, small-for-gestational-age infants, and infants with low birth weight. Studies indicate that pregnancy can motivate women with substance use disorders to seek treatment; however, there remains a dearth of comprehensive treatment programs geared toward pregnant and parenting women.

The AAP first published recommendations on substance-exposed infants in 1990, calling for non-punitive access to comprehensive care for pregnant women and their infants. Since then, more than 20 national organizations have published similar statements. Despite the strong consensus from the medical and public health community, there has been an increase in the number of states approving and considering criminal prosecution laws for pregnant women with substance use disorders.

“Pregnant women must be able to discuss their substance use openly with their medical providers without fear of punishment,” said co-author Davida M. Schiff, MD, FAAP. “Punitive policies towards pregnant women with substance use disorder are detrimental to the health of mother and baby.”

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The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.

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