CARE Series - Substance Use and Pregnancy: Update

Monday, July 21, 2025, 12:00 PM - Friday, July 21, 2028, 1:00 PM

AMA PRA Category 1 Credits™ (1.00 hours), ANCC Nursing Contact Hours (1.00 hours), CME-Designated Participation Credit (1.00 hours)

Review of:

• Tobacco and Nicotine use during pregnancy and postpartum

• Alcohol use during pregnancy

• Methadone and Buprenorphine medication management

• Managing Neonatal Abstinence

• Antidepressants during pregnancy:

  • treating and optimizing mental health

  • improving pain control

  • SSRI safety data

Presenter

Marjorie Meyer, MD
Professor of Obstetrics, Gynecology, & Reproductive Sciences
Vice Chair for Obstetrics
Division Director for Maternal Fetal Medicine
Larner College of Medicine, University of Vermont

Dr. Meyer is a Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, where she is Vice Chair for Obstetrics, the Division Director for Maternal Fetal Medicine, and the Medical Director for the Birthing Center. She is board certified in Obstetrics and Gynecology and in the subspecialty of Maternal Fetal Medicine (high risk pregnancy). She oversees the collaborative, multidisciplinary group of providers for the treatment of opioid use disorder during pregnancy and works closely with the state to develop clinical processes for optimization and coordination of care for all medically complicated, high-risk pregnancies.

1. Identify one short term and one long term impact of smoking on offspring health.
2. Describe the state of the evidence regarding the risk/benefit profile of pharmacotherapy for Alcohol Use Disorder during pregnancy.
3. Summarize recommendations for use of methadone, buprenorphine, and SSRIs during pregnancy.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours.

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

Registration/Requirements for Successful Completion
You may claim credit for successful completion of this online course. In order to claim credit, you must follow these steps:

1. Click the Register tab above. If you are not logged into your account, you will need to log in. Use the Forgot Your Password? button if you need to reset your password.

2. Register for the activity.

3. Click the Content/Tests tab and then View Content to view the recording. View the entire presentation.

4. Complete the Post-Test (attestation - return to the Content/Tests tab to find it).

5. Click the Complete Evaluation button, or click My Account in the menu bar; then click Evaluations.

6. Complete and Submit the Evaluation.

Bibliographic Material

• Abraham M, Alramadhan S, Iniguez C, Duijts L, Jaddoe VWV, Den Dekker HT, et al. (2017) A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS ONE 12(2): e0170946. https://doi.org/10.1371/journal.pone.0170946

• Allen H, Daw J. Perinatal Smoking Patterns From Preconception to 1-Year Post Partum. JAMA Netw Open. 2025 Jan 2;8(1):e2454974. https://doi.org/10.1001/jamanetworkopen.2024.54974. Erratum in: JAMA Netw Open. 2025 Feb 3;8(2):e253405. https://doi.org/10.1001/jamanetworkopen.2025.3405. PMID: 39821402; PMCID: PMC11742529.

• American College of Obstetricians and Gynecologists. Tobacco and Nicotine Cessation During Pregnancy. Committee Opinion. Number 807. May 2020. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/05/tobacco-and-nicotine-cessation-during-pregnancy

• American College of Obstetricians and Gynecologists. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum.

  Clinical Practice Guideline. Number 5. June, 2023. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/treatment-and-management-of-mental-health-conditions-during-pregnancy-and-postpartum

• Banderali, G., Martelli, A., Landi, M. et al. Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. J Transl Med 13, 327 (2015). https://doi.org/10.1186/s12967-015-0690-y

• Bernstein IM, Mongeon JA, Badger GJ, Solomon L, Heil SH, Higgins ST. Maternal smoking and its association with birth weight. Obstet Gynecol. 2005 Nov;106(5 Pt 1):986-91. https://doi.org/10.1097/01.AOG.0000182580.78402.d2. PMID: 16260516.

• Bhatt-Mehta V, Richards J, Sturza J, Schumacher RE. Impact of In-utero Exposure to Selective Serotonin Reuptake Inhibitors and Opioids on Neonatal Opioid Withdrawal Syndrome. J Addict Med. 2019 May/Jun;13(3):227-234. https://doi.org/10.1097/ADM.0000000000000484. PMID: 30489344.

• Borris JB, Dowd-Green C, Bowman LA, Nesbit SA, Fingerhood M, Stewart RW. Evaluation of opioid use disorder treatment outcomes in patients receiving split daily versus once daily dosing of buprenorphine-naloxone. J Subst Use Addict Treat. 2024 Jan;156:209209. https://doi.org/10.1016/j.josat.2023.209209. Epub 2023 Nov 6. PMID: 37939905.

• Braun, H. Potee, R. 2023. Individualizing methadone treatment with split dosing: An underutilized tool. Journal of Substance Use and Addiction Treatment. Volume 152. https://www.sciencedirect.com/science/article/abs/pii/S2949875923001479

• Devlin LA, Hu Z, Merhar SL, et al. Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial. JAMA Pediatr. 2024;178(6):525–532. https://doi.org/10.1001/jamapediatrics.2024.0544

• D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. https://doi.org/10.1001/jama.2015.3474. PMID: 25919527; PMCID: PMC4527523.

• D'Onofrio G, Edelman EJ, Hawk KF, Chawarski MC, Pantalon MV, Owens PH, Martel SH, Rothman R, Saheed M, Schwartz RP, Cowan E, Richardson L, Salsitz E, Lyons MS, Freiermuth C, Wilder C, Whiteside L, Tsui JI, Klein JW, Coupet E, O'Connor PG, Matthews AG, Murphy SM, Huntley K, Fiellin DA. Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. JAMA Netw Open. 2023 Apr 3;6(4):e235439. https://doi.org/10.1001/jamanetworkopen.2023.5439. PMID: 37017967; PMCID: PMC10077107.

• Haber, P.Identification and Treatment of Alcohol Use Disorder. 2025. New England Journal of Medicine. P 258-266. V 392.N 3. https://doi.org/10.1056/NEJMra2306511

• Kelty E, Terplan M, Greenland M, Preen D. Pharmacotherapies for the Treatment of Alcohol Use Disorders During Pregnancy: Time to Reconsider? Drugs. 2021 May;81(7):739-748. https://doi.org/10.1007/s40265-021-01509-x. Epub 2021 Apr 8. PMID: 33830479.

• Masarwa R, Bar-Oz B, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis. Am J Obstet Gynecol. 2019 Jan;220(1):57.e1-57.e13. https://doi.org/10.1016/j.ajog.2018.08.030. Epub 2018 Aug 28. PMID: 30170040.

• Nielsen T, Bernson D, Terplan M, Wakeman SE, Yule AM, Mehta PK, Bharel M, Diop H, Taveras EM, Wilens TE, Schiff DM. Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery. Addiction. 2020 Feb;115(2):291-301. https://doi.org/10.1111/add.14825. Epub 2019 Nov 13. PMID: 31692133; PMCID: PMC7066531.

• Ordean A, Tubman-Broeren M. Safety and Efficacy of Buprenorphine-Naloxone in Pregnancy: A Systematic Review of the Literature. Pathophysiology. 2023 Feb 11;30(1):27-36. https://doi.org/10.3390/pathophysiology30010004. PMID: 36810423; PMCID: PMC9944489.

• Roberts SCM, Schulte A, Zaugg C, Leslie DL, Corr TE, Liu G. Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment. JAMA Netw Open. 2023 Aug 1;6(8):e2327138. doi: 10.1001/jamanetworkopen.2023.27138. Erratum in: JAMA Netw Open. 2023 Oct 2;6(10):e2340368. https://doi.org/10.1001/jamanetworkopen.2023.40368. PMID: 37535355; PMCID: PMC10401306.

• Santa Clara University. Alcohol Assessment Tool. https://www.scu.edu/wellness/substance-use/alcohol-assessment-tool/

• Schiff DM, Nielsen TC, Hoeppner BB, Terplan M, Hadland SE, Bernson D, Greenfield SF, Bernstein J, Bharel M, Reddy J, Taveras EM, Kelly JF, Wilens TE. Methadone and buprenorphine discontinuation among postpartum women with opioid use disorder. Am J Obstet Gynecol. 2021 Oct;225(4):424.e1-424.e12. https://doi.org/10.1016/j.ajog.2021.04.210. Epub 2021 Apr 15. PMID: 33845029; PMCID: PMC8492487.

• Snyder H, Kalmin MM, Moulin A, Campbell A, Goodman-Meza D, Padwa H, Clayton S, Speener M, Shoptaw S, Herring AA. Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program. Ann Emerg Med. 2021 Dec;78(6):759-772. https://doi.org/10.1016/j.annemergmed.2021.05.024. Epub 2021 Aug 2. PMID: 34353655.

• Suarez EA, Bateman BT, Straub L, Hernández-Díaz S, Jones HE, Gray KJ, Connery HS, Davis JM, Lester B, Terplan M, Zhu Y, Vine SM, Mogun H, Huybrechts KF. First Trimester Use of Buprenorphine or Methadone and the Risk of Congenital Malformations. JAMA Intern Med. 2024 Mar 1;184(3):242-251. https://doi.org/10.1001/jamainternmed.2023.6986. Erratum in: JAMA Intern Med. 2024 Aug 1;184(8):993. https://doi.org/10.1001/jamainternmed.2024.3261. PMID: 38252426; PMCID: PMC10804281.

• Suarez, E.A et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. 2022. New England Journal of Medicine. P. 2033-2044. V 387. N 22. doi:10.1056/NEJMoa2203318. https://www.nejm.org/doi/full/10.1056/NEJMoa2203318

• Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD): US Department of Health and Human Services; 2008 May. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63952/

• US Centers for Disease Control and Prevention. Morbidity and Mortality Report Weekly, Jan 7, 2022. Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years — United States, 2018–2020. https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a2.htm#:~:text=During%202018–2020%2C%2013.5%25,more%20likely%20to%20consume%20alcohol.

• US Centers for Disease Control and Prevention. Morbidity and Mortality Report Weekly, May 2, 2024. Cigarette Smoking Among Pregnant Women During the Perinatal Period: Prevalence and Health Care Provider Inquiries — Pregnancy Risk Assessment Monitoring System, United States, 2021. https://www.cdc.gov/mmwr/volumes/73/wr/mm7317a2.htm

• US Department of Veterans Affairs. Alcohol use disorders identification test for consumption (AUDIT C). https://www.hepatitis.va.gov/alcohol/treatment/audit-c.asp

• US Preventive Services Task Force. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(3):265–279. https://doi.org/10.1001/jama.2020.25019

• US HHS Substance Abuse and Mental Health Services Administration. Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants https://library.samhsa.gov/product/clinical-guidance-treating-pregnant-and-parenting-women-opioid-use-disorder-and-their

• Young LW, Ounpraseuth ST, Merhar SL, Hu Z, Simon AE, Bremer AA, Lee JY, Das A, Crawford MM, Greenberg RG, Smith PB, Poindexter BB, Higgins RD, Walsh MC, Rice W, Paul DA, Maxwell JR, Telang S, Fung CM, Wright T, Reynolds AM, Hahn DW, Ross J, McAllister JM, Crowley M, Shaikh SK, Puopolo KM, Christ L, Brown J, Riccio J, Wong Ramsey K, Akshatha, Braswell EF, Tucker L, McAlmon KR, Dummula K, Weiner J, White JR, Howell MP, Newman S, Snowden JN, Devlin LA; ACT NOW Collaborative. Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal. N Engl J Med. 2023 Jun 22;388(25):2326-2337. https://doi.org/10.1056/NEJMoa2214470. Epub 2023 Apr 30. PMID: 37125831; PMCID: PMC10433732.

• Wang J, Cosci F. Neonatal Withdrawal Syndrome following Late in utero Exposure to Selective Serotonin Reuptake Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies. Psychother Psychosom. 2021;90(5):299-307. https://doi.org/10.1159/000516031. Epub 2021 May 10. PMID: 33971648.

• Wen X, Chung MV, Liszewski KA, et al. Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy. JAMA Netw Open. 2023;6(9):e2330249. https://doi.org/10.1001/jamanetworkopen.2023.30249

• Work EC, Muftu S, MacMillan KDL, Gray JR, Bell N, Terplan M, Jones HE, Reddy J, Wilens TE, Greenfield SF, Bernstein J, Schiff DM. Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder. Matern Child Health J. 2023 Dec;27(Suppl 1):104-112. https://doi.org/10.1007/s10995-023-03672-x. Epub 2023 May 31. PMID: 37253899; PMCID: PMC10229393.

• Wozniak JR, Riley EP, Charness ME. Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol. 2019 Aug;18(8):760-770. https://doi.org/10.1016/S1474-4422(19)30150-4. Epub 2019 May 31. PMID: 31160204; PMCID: PMC6995665.

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
ACE Office
Dartmouth Health
[email protected]

Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.