This case report describes two pregnant patients with dependence on kratom, an herbal substance with opioid-like effects sometimes used to self-manage opioid use disorder. Both experienced symptoms consistent with opioid withdrawal and were treated with opioid replacement medication, which relieved their symptoms. The authors recommend that obstetric clinicians ask about kratom use and recognize that dependence and withdrawal may require treatment. Because the report describes only two cases, it cannot establish the frequency of kratom-related pregnancy complications or the comparative safety of treatment options.
