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More than half of people who misuse opioids are women, many of whom are of childbearing age — yet optimal care for pregnant women with opioid addiction remains poorly defined. In a prospective cohort study, investigators describe the outcomes of prenatal care and pregnancy in 113 women with opioid use disorder who were followed by a multidisciplinary team at an urban “safety-net” hospital. More than 90% of participants used heroin, and most also used other drugs and alcohol. The majority reported physical (66%) and sexual (57%) abuse as well as prior incarceration; 23% had ongoing legal involvement.
Among women who initially received treatment with methadone (48%) or buprenorphine (52%), escalating doses were required as pregnancy progressed…