- Recognise rising peripartum OUD burden with maternal morbidity and neonatal abstinence syndrome risk; require coordinated maternal and neonatal care.
- Continue medication for opioid use disorder in pregnancy; methadone is a full agonist, buprenorphine is partial agonist, affecting dosing and monitoring.
- Peripartum anaesthesia requires early neuraxial analgesia, multimodal pain management, and avoidance of agents that precipitate withdrawal.
Anesthesiol Clin. 2026 Sep;44(3):395-410. doi: 10.1016/j.anclin.2026.04.001. Epub 2026 Jun 5.
ABSTRACT
This review discusses the rising impact of opioid use disorder (OUD) on peripartum care, highlighting the maternal and neonatal risks, including neonatal abstinence syndrome. It traces the US opioid crisis from aggressive 1990s prescribing to 2016 Center for Disease Control guidelines and notes enduring regional disparities in opioid prescriptions. The text distinguishes OUD from opioid-induced hyperalgesia and explains the pharmacology of methadone (full agonist) and buprenorphine (partial agonist), along with their implications for treatment during pregnancy. In obstetric anesthesia, coordinated, multimodal pain management is essential, with medication for opioid use disorder continuation, early neuraxial analgesia, and avoidance of withdrawal-precipitating agents.
PMID:42532612 | DOI:10.1016/j.anclin.2026.04.001
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