Overview

These guidelines contain recommendations on the identification and management of substance use and substance use disorders for health care services which assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder. They have been developed in response to requests from organizations, institutions and individuals for technical guidance on the identification and management of alcohol and other substance use and substance use disorders in pregnant women, with the target of healthy outcomes for both pregnant and their fetus or infant.

Contents

• ACKNOWLEDGEMENTS
• GLOSSARY OF TERMS USED IN THESE GUIDELINES
• ACRONYMS & ABBREVIATIONS
• EXECUTIVE SUMMARY
• INTRODUCTION
• WHY THESE GUIDELINES WERE DEVELOPED
• EXISTING RELEVANT GUIDELINES ON RELATED PROBLEMS AND DISORDERS
• WHO SHOULD USE THESE GUIDELINES
• OBJECTIVES AND SCOPE OF THE DOCUMENT
• INDIVIDUALS AND PARTNERS INVOLVED IN DEVELOPMENT OF THE GUIDELINES
  • WHO steering group
  • Guideline Development Group
  • External review group
  • Management of conflicts of interest
• HOW THE GUIDELINES WERE DEVELOPED
• EVIDENCE SEARCH AND RETRIEVAL
• EVIDENCE TO RECOMMENDATIONS
• RECOMMENDATIONS
  • Overarching principles
  • Screening and brief interventions for hazardous and harmful substance use during pregnancy
  • Psychosocial interventions for substance use disorders in pregnancy
  • Detoxification or quitting programmes for alcohol and other substance dependence in pregnancy
  • Pharmacological treatment (maintenance and relapse prevention) for alcohol and other substance dependence in pregnancy
  • Breastfeeding and maternal substance use
  • Management of infants exposed to alcohol and other psychoactive substances
• RESEARCH PRIORITIES AND GAPS
  • General Remarks
  • Exposure to different drugs and medications in utero
  • Screening
  • Brief interventions
  • Psychosocial interventions
  • Detoxification
  • Pharmacological treatment
  • Breastfeeding
  • Birth and labour
  • Management of infants exposed to alcohol or drugs in utero
• PLANS FOR DISSEMINATING, ADAPTING AND IMPLEMENTING THESE RECOMMENDATIONS
  • Local adaptation/implementation of these recommendations
• EVALUATING THE IMPACT OF THESE RECOMMENDATIONS
• REVIEW BY DATE
• ANNEX 1 EVIDENCE PROFILES
• ANNEX 2 SYSTEMATIC REVIEW METHODOLOGY
• ANNEX 3 SCREENING INSTRUMENTS FOR SUBSTANCE USE IN PRENATAL OR PREGNANT WOMEN
• ANNEX 4 COMPOSITION OF GUIDELINE GROUPS
• ANNEX 5 DECLARATIONS OF INTEREST

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.