Management of Kratom Use at Delivery

BACKGROUND: Kratom, a plant-derived supplement with both opioid and stimulant properties, is widely available and commonly used in the United States. There are significant risks associated with use during pregnancy, and it is important for obstetric clinicians to understand the importance of screening for use, counseling patients on potential risks and treatment options, and managing potential complications of exposure. CASE: We present the case of a pregnant individual who used daily kratom throughout pregnancy to manage chronic pain despite counseling about risks. She used the supplement at high enough doses to result in dependence and opioid tolerance and declined alternative treatments. This case report discusses the challenges and management considerations for delivery and postpartum care in pregnant patients using kratom. CONCLUSION: Pregnant individuals who use kratom are at risk for dependence, and special considerations are needed to manage withdrawal and pain during delivery and postpartum care.