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Illicit opioid use is a growing public health emergency and is associated with adverse medical and social outcomes. Opioid use in the pregnant population is increasing globally, and optimal management incorporates opioid substitution programs with improved concurrent engagement in medical care. The two main drugs used in opioid substitution programs are methadone and buprenorphine. Methadone has been used since the 1970s and provides treatment stability leading to improved engagement with obstetric services. Buprenorphine is a newer treatment, has greater dosing flexibility, and may be associated with fewer neonatal adverse effects. Direct comparisons of methadone and buprenorphine treatments are limited but suggest that buprenorphine is associated with less severe neonatal withdrawal; however, it is not universally well-tolerated and tends to be prescribed to less severely affected mothers. Given the lack of clear evidence to support one opioid substitution therapy over another, the principal aim of therapy should be to stabilize treatment and promote more comprehensive engagement with multidisciplinary services. [ABSTRACT FROM AUTHOR]

This decision, and any subsequent surgery and anaesthesia, should be undertaken by senior staff in consultation with obstetric, neonatology, midwifery and obstetric anaesthetic teams. Identifying research priorities in anaesthesia and peri-operative care: final report of the joint National Institute of academic Anaesthesia/James Lind Alliance research priority setting partnership. Keywords: anaesthesia; complications; pre-natal EN anaesthesia complications pre-natal 143 146 4 01/10/23 20230201 NES 230201 Surgery for non-obstetric issues occurs in up to 1:100 pregnancies and can be an anxiety-provoking experience for the mother and healthcare staff, with concerns for maternal and fetal well-being [[1]]. Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study. [Extracted from the article]