Abstract
Substance use disorder and opioid use disorder in pregnancy have serious maternal and neonatal sequelae, including neonatal abstinence syndrome, preterm labor, and intrauterine growth restriction. Despite this, there are limited resources and guidelines to help clinicians support these mothers in all practice settings. The primary aim of this review will be to provide evidence-based clinical, practitioner, and sociopolitical recommendations for obstetric teams to implement. A holistic approach that includes multidisciplinary team-based care, a stepwise approach to chronic pain management, treating patients with dignity and respect, and universal drug screening with patient consent is advised. Utilization of Screening, Brief-Intervention, and Referral to Treatment and expanding access to medications for opioid use disorder are also integral. Other key recommendations include addressing social determinants of health, optimizing technology and telehealth, reimbursing preventative care, and improving contraceptive planning. Following these recommendations may address gaps in resource-poor areas and improve maternal and neonatal outcomes.