Home > Substance use in pregnancy.

Wong, Suzanne and Ordean, Alice and Kahan, Meldon [National Guideline Clearinghouse] . (2011) Substance use in pregnancy. Society of Obstetricians and Gynaecologists of Canada. Journal of Obstetrics and Gynaecology Canada, 33 (4) 367–38. SOGC Clinical practice guideline no. 256

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URL: http://guidelines.gov/content.aspx?f=rss&id=33136

Objective: To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers.

Options: This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy.
Outcomes: Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation.

Benefits, harms, and costs: This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality.

Recommendations
1._All pregnant women and women of childbearing age should be screened periodically for alcohol, tobacco, and prescription and illicit drug use. (III-A)
2._When testing for substance use is clinically indicated, urine drug screening is the preferred method. (II-2A) Informed consent should be obtained from the woman before maternal drug toxicology testing is ordered. (III-B)
3._Policies and legal requirements with respect to drug testing of newborns may vary by jurisdiction, and caregivers should be familiar with the regulations in their region. (III-A)
4._Health care providers should employ a flexible approach to the care of women who have substance use problems, and they should encourage the use of all available community resources. (II-2B)
5._Women should be counselled about the risks of periconception, antepartum, and postpartum drug use. (III-B)
6._Smoking cessation counselling should be considered as a first-line intervention for pregnant smokers. (I-A) Nicotine replacement therapy and/or pharmacotherapy can be considered if counselling is not successful. (I-A)
7._Methadone maintenance treatment should be standard of care for opioid-dependent women during pregnancy. (II-IA) Other slow-release opioid preparations may be considered if methadone is not available. (II-2B)
8._Opioid detoxification should be reserved for selected women because of the high risk of relapse to opioids. (II-2B)
9._Opiate-dependent women should be informed that neonates exposed to heroin, prescription opioids, methadone, or buprenorphine during pregnancy are monitored closely for symptoms and signs of neonatal withdrawal (neonatal abstinence syndrome). (II-2B) Hospitals providing obstetric care should develop a protocol for assessment and management of neonates exposed to opiates during pregnancy. (III-B)
10._Antenatal planning for intrapartum and postpartum analgesia may be offered for all women in consultation with appropriate health care providers. (III-B)
11._The risks and benefits of breastfeeding should be weighed on an individual basis because methadone maintenance therapy is not a contraindication to breastfeeding. (II-3B)


Item Type:Evidence resource
Publication Type:Review
Drug Type:Cannabis, Alcohol or other drugs in general, Inhalents and solvents, CNS stimulants, Alcohol, Prescription/Over the counter, Tobacco, CNS depressants, Opioid, Cocaine
Intervention Type:AOD disorder treatment method, AOD disorder harm reduction, Screening, Psychosocial treatment method
Source:National Guideline Clearinghouse
Date:2011
Pages:367–38
Publisher:Society of Obstetricians and Gynaecologists of Canada
Volume:33
Number:4
EndNote:View
Accession Number:HRB (Not in collection)
Subjects:HJ Treatment method > Substance disorder treatment method
E Concepts in biomedical areas > Pregnancy
T Demographic characteristics > Pregnant woman
J Health care, prevention and rehabilitation > Substance use prevention > Substance use harm reduction
E Concepts in biomedical areas > Pregnancy > Reproductive effects of substance use
HJ Treatment method > Psychosocial treatment method
A Substance use, abuse, and dependence > Prevalence
A Substance use, abuse, and dependence > Effects and consequences

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