Discussion Table Topic: Discussion of the WHO Guidelines on Pregnancy and Substance Use Disorder

Included below are 18 recommendations to be discussed compiled by the co-chairs in preparation of the Discussion of the WHO Guidelines on Pregnancy and Substance Use Disorder discussion table that will be held from 16:15-17:30 on Friday, 2011 InWomen's Conference - Hollywood, FL 076June 12, 2015 at the InWomen’s Conference.

IDENTIFICATION AND MANAGEMENT OF SUBSTANCE USE AND SUBSTANCE USE DISORDERS IN PREGNANCY

Screening and brief interventions for hazardous and harmful substance use during pregnancy

1 Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal visit. Strong Low

2 Health-care providers should offer a brief intervention to all pregnant women using alcohol or drugs. Strong Low

3 Health-care providers managing pregnant or postpartum women with alcohol or other substance use disorders should offer comprehensive assessment2, and individualized care. Conditional Very low

4 Health-care providers should at the earliest opportunity advise pregnant women dependent on alcohol or drugs to cease their alcohol or drug use and offer, or refer to, detoxification services under medical supervision where necessary and applicable. Strong Very low

5 Pregnant women dependent on opioids should be encouraged to use opioid maintenance treatment5 whenever available rather than to attempt opioid detoxification. Strong Very low

6 Pregnant women with benzodiazepine dependence should undergo a gradual6 dose reduction, using long-acting benzodiazepines. Strong Very low

7 Pregnant women who develop withdrawal symptoms following the cessation of alcohol consumption should be managed with the short-term use of a long-acting benzodiazepine. Strong Very low

8 In withdrawal management for pregnant women with stimulant dependence, psychopharmacological medications may be useful to assist with symptoms of psychiatric disorders but are not routinely required. Strong Very low

9 Pharmacotherapy is not recommended for routine treatment of dependence on amphetamine-type stimulants, cannabis, cocaine, or volatile agents in pregnant patients. Conditional Very low

10 Given that the safety and efficacy of medications for the treatment of alcohol dependence has not been established in pregnancy, an individual risk-benefit analysis should be conducted for each woman. Conditional Very low

11 Pregnant patients with opioid dependence should be advised to continue or commence opioid maintenance therapy with either methadone or buprenorphine. Strong Very low

12 A. Mothers with substance use disorders should be encouraged to breastfeed unless the risks clearly outweigh the benefits. B. Breastfeeding women using alcohol or drugs should be advised and supported to cease alcohol or drug use; however, substance use is not necessarily a contraindication to breastfeeding.Conditional Low

13 Skin-to-skin contact is important regardless of feeding choice and needs to be actively encouraged for the mother with a substance use disorder who is able to respond to her baby’s needs. Strong Low

14 Mothers who are stable on opioid maintenance treatment with either methadone or buprenorphine should be encouraged to breastfeed unless the risks clearly outweigh the benefits. Strong Low

15 Health-care facilities providing obstetric care should have a protocol in place for identifying, assessing, monitoring and intervening, using non-pharmacological and pharmacological methods, for neonates prenatally exposed to opioids. Strong Very low

16 An opioid should be used as initial treatment for an infant with neonatal opioid withdrawal syndrome if required. Strong Very low

17 If an infant has signs of a neonatal withdrawal syndrome due to withdrawal from sedatives or alcohol, or the substance the infant was exposed to is unknown, then phenobarbital may be a preferable initial treatment option. Conditional Very low

18 All infants born to women with alcohol use disorders should be assessed for signs of fetal alcohol syndrome. Conditional Very low

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