Facing addiction can seem insurmountable—especially when opioids are involved. Doubts of one’s ability to stay substance-free; fears around judgment from family, friends, and society; and efforts to manage addiction while continuing balancing life’s responsibilities can compound. Pregnancy adds a significant layer to an already difficult situation.

These are the situations and questions presented to thousands of pregnant people every year. According to CDC research published last year from self-reported data, roughly 7% of pregnant people reported they took opioid drugs during pregnancy, and of those 7%, one in five reported inappropriate opioid use—taking an amount or substance not prescribed by a clinician.

In response to seeing patients with these types of challenges at Penn Family Care, Ayiti-Carmel Maharaj-Best, Navid Roder, and Judy Chertok, all assistant professors of clinical family medicine and community health in the Perelman School of Medicine, and their team established the Penn PROUD (Perinatal Resources for Opioid Use Disorder) Clinic at Penn Family Care last summer. Together, the team provides both primary care and prenatal care to expectant patients before, during, and after birth as well as care for the newborn. In just months, the clinic has cared for dozens of pregnant patients with OUD and is poised to care for many more.

Some patients who receive care at the PROUD Clinic are identified through screening for substance use during their primary care or prenatal visits. Other patients come specifically seeking help for OUD.While it might seem that stopping “cold turkey” might be the best way to prevent bad outcomes during pregnancy, research has shown that this approach is not necessarily the safest, says Maharaj-Best.

Withdrawal can actually lead to stress and miscarriage. “Rates of relapse are high especially in stressful times like during pregnancy and postpartum,” she says. “This puts patients at a high risk for overdose or possibly death, which is where medication can be helpful.”