Objectives:

To compare different treatment options according to maternal and neonatal outcomes in pregnant women with opioid use disorder (OUD).

Background:
Opioid use during pregnancy has been an increasing problem over the last two decades, making it an ongoing public health issue worldwide.
Pregnant women with OUD can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment.
Maternal opioid use results in harmful medical and social consequences for both mother and infant. Both opioid intoxication and acute withdrawal can cause harm. Opioid use can increase the risk of spontaneous abortion, stillbirth and prematurity. Abrupt withdrawal can lead to preterm labor, fetal distress, and fetal withdrawal symptoms.

Materials and Methods:
A non-systematic Pubmed/MEDLINE search was conducted using the terms: ”opioid use disorder”, “pregnancy”, "methadone", "buprenorphine" and "naltrexone”.
The research was limited to articles published in the last 5 years.

Results and Conclusions:
Both methadone and buprenorphine are widely used to treat opioid use disorder. However, compared with methadone, buprenorphine is associated with shorter treatment duration, less medication needed to treat neonatal abstinence syndrome symptoms and shorter hospitalizations for neonates.
Despite being the standard of care, medication-assisted treatment with methadone or buprenorphine is still underused, making it apparent that more options are necessary. Naltrexone is not a first-line treatment primarily because both detoxification and an opioid-free period are required. 
Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

14 - Treatment of pregnant women with opioid use disorder – what can we do?