Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 32

Pregnancy is an opportune time to assess behavioral health conditions in general, and substance use and addiction in particular. Universal screening with a validated instrument is recommended as a routine part of prenatal care. The following instruments have been studied in a comparative study design: the Substance Use Risk Profile‐Pregnancy (SURP‐P), CRAFFT, 5Ps (parents, peers, partner, pregnancy, past), Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (NIDA) Quick Screen. All perform with similar efficacy though none has both high sensitivity and high specificity. Screening should occur at the first prenatal care visit, every trimester, and, especially, postpartum. Urine drug testing is not a substitute for screening. Urine drug tests, especially point‐of‐care tests, do not capture certain substances (such as alcohol, nicotine and many synthetic opioids including fentanyl) and are plagued by false‐positive results due to medications commonly utilized in pregnancy and during labor and delivery.

Most people who use substances quit or cut back during pregnancy. However, some people cannot, most likely because they have an addiction. While it is very rare for a woman to develop an addiction during pregnancy, some people with addiction get pregnant and may initially present for care during pregnancy. Opioid addiction (also termed opioid use disorder) is a chronic and treatable disease. Symptoms of addiction include inordinate amount of time spent craving, obtaining, using, and recovering from a substance; compulsive use; use that interferes with school, job, family, and other aspects of social life; and continued use despite harms to self and others. Opioid addiction should be diagnosed with the framework detailed in the DSM‐5.