Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study

Advances in Psychotropic Treatment for Pregnant Women: Efficacy, Adverse Outcomes, and Therapeutic Monitoring

Advancements in psychotropic therapy for pregnant women are pivotal for addressing maternal mental health during the perinatal period. Screening for mood and anxiety symptoms during pregnancy is recommended to enable early intervention. Psychotropic medications, including antidepressants, benzodiazepines, antipsychotics, and mood stabilizers, are commonly used, but challenges remain regarding their safety and efficacy during pregnancy. Pregnancy induces significant changes in pharmacokinetics, necessitating personalized dosing strategies and careful monitoring. Real-time monitoring technologies, such as smartphone-integrated platforms and home-based monitoring, enhance accessibility and accuracy. Prospective studies and collaboration among healthcare providers are essential for evidence-based guidelines and optimal treatment strategies. Reducing stigma around mental health during pregnancy is crucial to ensure women seek help and discuss treatment options, promoting understanding and acceptance within the community.

Patient navigation for perinatal substance use disorder treatment: A systematic review

BACKGROUND

Substance use during the perinatal period (i.e., pregnancy through the first year postpartum) can pose significant maternal and infant health risks. However, access to lifesaving medications and standard care remains low for perinatal persons who use substances. This lack of substance use disorder treatment access stems from fragmented services, stigma, and social determinants of health-related barriers that could be addressed using patient navigators. This systematic review describes patient navigation models of care for perinatal people who use substances and associated outcomes.

METHODS

We conducted a structured search of peer-reviewed, US-focused, English- or Spanish-language articles from 2000 to 2023 focused on 1) patient navigation, 2) prenatal and postpartum care, and 3) substance use treatment programs using PubMed, Scopus, PsycINFO, and CINAHL databases.

RESULTS

After meeting eligibility criteria, 17 studies were included in this review. The majority (n=8) described outpatient patient navigation programs, with notable hospital (n=4) and residential (n=3) programs. Patient navigation was associated with reduced maternal substance use, increased receipt of services, and improved maternal and neonatal health. Findings were mixed for engagement in substance use disorder treatment and child custody outcomes. Programs that co-located care, engaged patients across the perinatal period, and worked to build trust and communication with family members and service providers were particularly successful.

CONCLUSION

Patient navigation may be a promising strategy for improving maternal and infant health outcomes among perinatal persons who use substances. More experimental research is needed to test the effect of patient navigation programs for perinatal persons who use substances compared to other models of care.

Growing together: Optimization of care through quality improvement for the mother/infant dyad affected by perinatal opioid use

The care of the dyad affected by opioid use disorder (OUD) requires a multi-disciplinary approach that can be challenging for institutions to develop and maintain. However, over the years, many institutions have developed quality improvement (QI) initiatives aimed at improving outcomes for the mother, baby, and family. Over time, QI efforts targeting OUD in the perinatal period have evolved from focusing separately on the mother and baby to efforts addressing care of the dyad and family during pregnancy, delivery, and postpartum. Here, we review recent and impactful QI initiatives that serve as examples of work improving outcomes for this population. Further, we advocate that this work be done through a racial equity lens, given ongoing inequities in the care of particularly non-white populations with substance use disorders. Through QI frameworks, even small interventions can result in meaningful changes to the care of babies and families and improved outcomes.

Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial

BACKGROUND AND AIMS

Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC).

DESIGN

This study was a pilot single-blinded multi-site randomized trial.

SETTING

Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated.

PARTICIPANTS

One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49).

INTERVENTION

PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2- and 6-month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management.

MEASUREMENTS

Feasibility assessments included consent, session delivery and assessment rates. Mixed-effect models for intent-to-treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non-prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum.

FINDINGS

We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non-prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = -10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = -0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = -21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%).

CONCLUSIONS

Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large-scale trial.

Implementing a clinical checklist for pregnant patients with opioid use disorder

BACKGROUND

Opioid use disorder (OUD) has been increasing in pregnant patients over the past two decades. Best practice guidelines that are available for these patients, must now be implemented by health care teams. Clinical checklists have been used for other complex patient cohorts with good success and are a potentially viable tool for ensuring best practices with this patient population as well.

LOCAL PROBLEM

Maine has seen a dramatic increase in the number of pregnant patients with OUD. Many of these patients seemed to "fall through the cracks" in the traditional prenatal care model. The obstetrical care team expressed feeling overwhelmed by the complex care needs of these patients and unsure of how to improve their care.

METHODS

To improve prenatal care delivery for patients with OUD, we implemented an evidence-based clinical checklist. This local, NP-led quality improvement project was done in partnership with a state-led initiative to improve perinatal care for patients with OUD.

INTERVENTIONS

An evidence-based checklist provided by the state initiative was implemented for prenatal patients with diagnosed OUD.

RESULTS

Use of a clinical checklist for patients with OUD increased the rate of several best practices during their prenatal care, including emergency naloxone prescription, tracking prescription monitoring reports, and contraceptive planning. Rates of completed prenatal screening for substance misuse, social determinants of health, and intimate partner violence also increased in our practice overall, as a result of this project.

CONCLUSIONS

To further improve perinatal care coordination for patients with OUD, we recommend future evaluation of clinical checklists within various practice settings.

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review

Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.

Opioid Use Disorder and Overdose in the First Year Postpartum: A Rapid Scoping Review and Implications for Future Research

OBJECTIVE

Opioid overdose is a leading cause of maternal mortality, yet limited attention has been given to the consequences of opioid use disorder (OUD) in the year following delivery when most drug-related deaths occur. This article provides an overview of the literature on OUD and overdose in the first year postpartum and provides recommendations to advance maternal opioid research.

APPROACH

A rapid scoping review of peer-reviewed research (2010-2021) on OUD and overdose in the year following delivery was conducted in PubMed, PsycINFO, and Web of Science databases. This article discusses existing research, remaining knowledge gaps, and methodological considerations needed.

RESULTS

Seven studies were included. Medication for OUD (MOUD) was the only identified factor associated with a reduction in overdose rates. Key literature gaps include the role of mental health disorders and co-occurring substance use, as well as interpersonal, social, and environmental contexts that may contribute to postpartum opioid problems and overdose.

CONCLUSION

There remains a limited understanding of why women in the first year postpartum are particularly vulnerable to opioid overdose. Recommendations include: (1) identifying subgroups of women with OUD at highest risk for postpartum overdose, (2) assessing opioid use, overdose, and risks throughout the first year postpartum, (3) evaluating the effect of co-occurring physical and mental health conditions and substance use disorders, (4) investigating the social and contextual determinants of opioid use and overdose after delivery, (5) increasing MOUD retention and treatment engagement postpartum, and (6) utilizing rigorous and multidisciplinary research methods to understand and prevent postpartum overdose.

Nonfatal Overdoses Among Pregnant Individuals With Opioid Use Disorder

Little is understood about overdose history among pregnant individuals with opioid use disorder (OUD). We performed a cross-sectional secondary analysis of data from the OPTI-Mom 2.0 (Optimizing Pregnancy and Treatment Interventions for Moms 2.0) study (NCT03833245), a multi-site randomized controlled trial of patient navigation and usual care. We summarized participant demographics, overdose history, and substances involved in most recent overdose. Of the 102 participants with severe OUD included, 64.7% (95% CI 54.8-73.4%) had a reported a history of an overdose event and 41.2% (95% CI 31-52%) reported at least one overdose within the past year. In the most recent overdose, 81.8% (95% CI 70.4-89.5%) reported using opioids and 30.3% (95% CI 20.3-42.6%) reported using sedatives. These findings suggest need for heightened awareness of overdose-reduction and harm-reduction strategies in this population.

Differences in buprenorphine treatment quality across physician provider specialties

BACKGROUND

The number and types of clinicians prescribing buprenorphine treatment for opioid use disorder (OUD) have increased over the past two decades, but there is little information on how potential indicators of quality of care to patients receiving buprenorphine vary by provider specialty.

METHODS

We used the Medicaid Analytic eXtract from 2009 to 2014 to identify buprenorphine treatment episodes. We assigned physician specialties to episodes based on whether an episode had at least one outpatient claim linked to specialists in addiction, behavioral health, opioid treatment program (OTP), pain, or primary care provider (PCP). We then used logistic regressions to estimate the association of linked physician specialty and achievement of the following process of care measures: at least 180-day duration, no co-occurring opioid analgesics, no co-occurring benzodiazepines, infectious disease screening, liver function test, drug and toxicology screenings, evaluation and management visits, and counseling.

RESULTS

Episodes linked to PCPs had significantly lower odds of achieving 180-day duration, an absence of opioid analgesics, an absence of benzodiazepines, drug and toxicology screenings, and counseling compared to addiction, behavioral health, and/or OTPs. Episodes linked to PCPs had significantly higher odds of undergoing infectious disease screenings, liver function tests, and evaluation and management visits compared to all specialty categories.

CONCLUSIONS

Episodes were more likely to achieve process of care measures related to the specialties of their physicians, but no specialty consistently demonstrated better performance compared to PCPs. Our findings highlight the need for models that can better integrate physical and behavioral health services for OUD treatment.

Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program

OBJECTIVE

To evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services.

DESIGN

An interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan-do-study-act cycles to develop an integrated prenatal and opioid use disorder program.

SETTING/LOCAL PROBLEM

An urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people.

PARTICIPANTS

Connections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal-child services in the community.

INTERVENTION/MEASURES

Partnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners.

RESULTS

In the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful.

CONCLUSION

An urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, us destigmatizing in nature, and can lead to improved maternal and fetal outcomes.

Differential Gateways, Facilitators, and Barriers to Substance Use Disorder Treatment for Pregnant Women and Mothers: A Scoping Systematic Review

OBJECTIVES

Access to substance use disorder (SUD) treatment is complex, and more so for pregnant women and mothers who experience unique barriers. This scoping systematic review aimed to summarize contemporary findings on gateways, facilitators, and barriers to treatment for pregnant women and mothers with SUD.

METHODS

We used the scoping review methodology and a systematic search strategy via MEDLINE/PubMed and Google Scholar. The search was augmented by the similar article lists for sources identified in PubMed. Scholarly and peer-reviewed articles that were published in English from 1996 to 2019 were included. A thematic analysis of the selected studies was used to summarize pathways to SUD treatment and to identify research gaps.

RESULTS

The analysis included 41 articles. Multiple gateway institutions were identified: health care settings, social service agencies, criminal justice settings, community organizations, and employers. Some of the identified facilitators and barriers to SUD treatment were unique to pregnant women and mothers (eg, fear of incarceration for child abuse). Both personal (emotional support and social support) and child-related factors (loss of children, suspension or termination of parental rights, the anticipation of reuniting with children) motivated women to seek treatment. Major access barriers included fear, stigma, charges of child abuse, inconvenience, and financial hardship.

CONCLUSIONS

There has been progress in implementing different types of interventions and treatments for that were attentive to pregnant women and mothers' needs. We developed a conceptual model that characterized women's pathways to treatment by deciphering women's potential engagement in gateway settings.

Non-pharmacologic interventions to improve depression and anxiety among pregnant and parenting women who use substances: An integrative literature review

Pregnant and parenting women who use substances report high rates of comorbid depression and anxiety. Due to the significant impact of this comorbidity on treatment adherence and maternal/child outcomes, effective psychosocial and behavioral interventions to address depression and anxiety in this population are necessary. A directed search of PubMed, PsycINFO, and CINAHL databases produced 22 articles from 20 distinct studies examining non-pharmacologic interventions with an effect on depression and anxiety among pregnant or parenting women using substances. Of the 20 studies reviewed, 8 were randomized controlled trials, 7 were quasi-experimental studies, and 5 were cohort studies. Results revealed a wide array of interventions targeting intrapersonal, interpersonal, and/or structural factors within these women's lives. Parenting therapy and psychosocially enhanced treatment programs had the strongest evidence for positive treatment effect in improving symptoms of depression and anxiety. The use of contingency-management, case-managed care, patient or wellness navigators, mindfulness-based therapy, maternal-child relationship-focused therapy, family therapy, peer support, and therapeutic community-based interventions show promise but warrant further experimental exploration. Comprehensive and gender-specific residential treatment was observationally associated with improvements in depression and anxiety; however, the specific modality of efficacy is unclear. Future research should focus on identifying which modalities are most cost-effective, feasible, and acceptable among this uniquely vulnerable population.

Treatment access for opioid use disorder in pregnancy among rural and American Indian communities

BACKGROUND

Opioid use disorder (OUD) in pregnancy disproportionately impacts rural and American Indian (AI) communities. With limited data available about access to care for these populations, this study's objective was to assess clinic knowledge and new patient access for OUD treatment in three rural U.S. counties.

MATERIAL AND METHODS

The research team used unannounced standardized patients (USPs) to request new patient appointments by phone for white and AI pregnant individuals with OUD at primary care and OB/GYN clinics that provide prenatal care in three rural Utah counties. We assessed a) clinic familiarity with buprenorphine for OUD; b) appointment availability for buprenorphine treatment; c) appointment wait times; d) referral provision when care was unavailable; and e) availability of OUD care at referral locations. We compared outcomes for AI and white USP profiles using descriptive statistics.

RESULTS

The USPs made 34 calls to 17 clinics, including 4 with publicly listed buprenorphine prescribers on the Substance Abuse and Mental Health Services Administration website. Among clinical staff answering calls, 16 (47%) were unfamiliar with buprenorphine. OUD treatment was offered when requested in 6 calls (17.6%), with a median appointment wait time of 2.5 days (IQR 1-5). Among clinics with a listed buprenorphine prescriber, 2 of 4 (50%) offered OUD treatment. Most clinics (n = 24/28, 85.7%) not offering OUD treatment provided a referral; however, a buprenorphine provider was unavailable/unreachable 67% of the time. The study observed no differences in appointment availability between AI and white individuals.

CONCLUSIONS

Rural-dwelling AI and white pregnant individuals with OUD experience significant barriers to accessing care. Improving OUD knowledge and referral practices among rural clinics may increase access to care for this high-risk population.

Adjunct interventions to standard medical management of buprenorphine in outpatient settings: A systematic review of the evidence

BACKGROUND

A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings.

METHODS

We included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes.

RESULTS

The final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes.

CONCLUSIONS

Research is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.

Women-centered drug treatment models for pregnant women with opioid use disorder: A scoping review

BACKGROUND

While there is a high unmet need for drug treatment services tailored to the needs of pregnant women, fewer than half of the opioid use disorder (OUD) treatment programs in the U.S. offer such services. We conducted a scoping review of the literature to identify women-centered drug treatment models that address access, coordination, and quality of care, and their facilitators and barriers.

METHODS

We searched PubMed, EMBASE, PsycInfo, Sociology Database, Web of Science, CINAHL, EBSCO Open Dissertations, Health Services Research Projects in Progress, and relevant agency websites from 1990 to 2020. We included studies that evaluated multicomponent models of care that provided medication for OUD (MOUD) to pregnant women in the U.S.

RESULTS

Of the 1,578 unduplicated articles screened, 26 articles met the inclusion criteria, which reported on 19 different studies and included 3,193 women. We identified seven different models of care and found that: (1) access was improved by co-locating various services for drug treatment and care, (2) coordination was enhanced by inter-professional collaboration, (3) quality was improved by treating pregnant patients in groups, and (4) stigmatization and criminalization of substance use during pregnancy was a significant barrier to care.

CONCLUSIONS

There is an urgent need to bolster patient-provider relationships that are built on trust, are free of stigma, and that empower patients to make their own decisions. Improved policies and regulations to reduce stigma around the use of opioids and MOUD are needed, so that pregnant women with OUD can access high quality care.

Nurses' Priorities for Improving Pregnancy and Birth Care for Individuals with Opioid use Disorder

INTRODUCTION

The motivation to seek treatment for opioid use disorder (OUD) can increase during the perinatal period. However, several identified barriers, such as poor access to services, lack of trained providers, stigma, and legal ramifications of OUD, limit the ability for individuals with OUD to receive safe and supportive care during pregnancy and birth. During the birth hospital stay in particular, nurses provide the majority of care for pregnant and birthing families. We aimed to engage nurses, with experience caring for pregnant and postpartum individuals with OUD, in priority setting as a way to identify areas of need in the current health care systems.

METHODS

Using community-engaged priority setting methods, we recruited a sample of 47 nurses (phase 1) and 20 nurses (phase 2), including nurse-midwives and other advanced practice nurses, at a statewide nursing conference, who reported regularly providing care for pregnant and postpartum individuals with OUD. We invited participants to submit questions and concerns regarding the provision of care for individuals with OUD (phase 1). A selection of those who submitted questions attended a focus group to rank and prioritize submitted questions into a set of priorities for research, policy, and care improvement (phase 2).

RESULTS

In phase 1, participants submitted a total of 165 questions and concerns. In phase 2, participants prioritized the following: funding to support improvements in OUD care in the perinatal period, increased access to services, supportive housing for individuals in recovery, standardization of care for individuals with OUD, and efforts to destigmatize care.

DISCUSSION

Nurses who work with pregnant and postpartum individuals with OUD have a unique insight as to how health care providers, including midwives, can better support this community and should be engaged setting priorities for research, changes to policy, and improvement in care.

Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

Women of childbearing age who misuse opioids are a particularly vulnerable population, and their barriers to treatment are unique because of their caregiver roles. Research on treatment for opioid use generally draws from urban and rural areas. This study fills a gap in research that focuses on barriers and motivators to opioid treatment in suburban areas. The aim of this study was to give voice to suburban pregnant women and mothers caring for children while using opioids. Ethnographic methods were used for recruitment, and 58 in-depth interviews were analyzed using a modified grounded theory approach. Barriers to medication-assisted treatment (MAT) included stigma, staff attitudes, and perceptions the women had about MAT treatment. Barriers associated with all types of treatment included structural factors and access difficulties. Relationships with partners, friends, family, and providers could be barriers as well as motivators, depending on the social context of the women’s situation. Our findings suggest increasing treatment-seeking motivators for mothers and pregnant women by identifying lack of resources, more empathetic consideration of social environments, and implementing structural changes to overcome barriers. Findings provide a contemporary understanding of how suburban landscapes affect mothers’ treatment-seeking for opioid dependence and suggest the need for more focus on emotional and structural resources rather than strict surveillance of women with opioid dependence who are pregnant or caring for children.

Community-led Priority Setting for Opioid Use Disorder in Pregnancy and Parenting

OBJECTIVES

To engage community members with opioid use disorder (OUD) and case managers working with pregnant and parenting individuals with OUD in a priority setting process to identify the key priorities for research, policy, and care improvement during pregnancy, birth, and postpartum.

METHODS

We conducted focus groups across Washington State with pregnant and parenting people with OUD and with case managers working with this community as part of research priority setting using the validated Research Prioritization by Affected Communities protocol. Priorities for research, policy, and service improvement were developed during each focus group by the participants.

RESULTS

Three focus groups with pregnant and parenting people with OUD and 2 focus groups with case managers were conducted (total N = 24 and 16, respectively). Both prioritized topics such as stigma and bias, housing, access to treatment, and steps toward successful recovery. The community and case manager groups shared similar, complementary strategies for each priority, with differences reflecting their perspectives in relation to OUD.

CONCLUSIONS

Community-engaged priority setting among those with OUD was an effective and meaningful way to guide future research, policy, and care improvement efforts.

A review of nonpharmacological adjunctive treatment for postpartum women with opioid use disorder

INTRODUCTION

Over the past decade, opioid use disorder (OUD) among pregnant women has increased by over 400%. Although medication assisted treatment (MAT) provides necessary care for women with OUD, effective adjunctive nonpharmacological treatments have not been systematically identified. This is especially concerning for the postpartum period, which includes several unique risk factors (e.g., sleep deprivation, mood disturbances) for MAT non-adherence and relapse. This review summarizes the existing knowledge regarding nonpharmacological treatments for OUD during the postpartum period, as well as provides recommendations for the future.

METHODS

PubMed and PsycINFO were searched in July 2018 using combinations of 28 keywords. Eligibility criteria included: (1) coverage of postpartum period, (2) use of nonpharmacological treatment for OUD, (3) conducted in clinical samples, and (4) written in English.

RESULTS

A total of 4 out of 38 identified articles met eligibility criteria. Two of the studies offered weekly on-site group counseling, with one also offering monthly social worker meetings. The third study offered four sessions with a patient navigator during the postpartum period. The last offered an employment intervention. All four reported favorable effects on OUD at end of follow-up (range: 30 days postpartum to 1 year postpartum). However, the details of the interventions, methodologies, and abstinence rates were sparse.

DISCUSSION

Few published studies examine nonpharmacological OUD treatments specific to the postpartum period. Identification of adjunctive nonpharmacological treatments designed to the unique needs of postpartum women is of critical public health importance, and further research is needed.

Treatment for substance use disorders in pregnant women: Motivators and barriers

BACKGROUND

Pregnancy is a unique opportunity to provide broad and necessary medical care for women- including treatment for Substance Use Disorders (SUD). The standard of care for SUD in pregnant women is treatment at a comprehensive care facility. There is little existing qualitative research exploring what brings pregnant women with SUD to treatment and what barriers to treatment exist for this population. This study explored women's self-reported reasons for pursuing treatment or hesitating to do so.

METHODS

This qualitative study used interviews to explore common factors that motivate pregnant women with SUD to seek comprehensive care during pregnancy and common hesitations/ barriers to treatment. The study population included 20 women in treatment at a comprehensive care facility for pregnant and parenting women at Johns Hopkins. Participants volunteered to do interviews which were recorded and transcribed for analysis.

RESULTS

Interviews revealed several major themes in motivators to seek treatment: readiness to stop using, concern for the baby's health, concern about custody of the baby or other children, wanting to escape violent environments or homelessness, and seeking structure. Barriers to treatment included fear of loss of custody, not wanting to be away from children/partner, concern about stigma or privacy, and lack of childcare and transportation.

CONCLUSIONS

This study revealed common motivators to seek treatment and barriers to treatment for pregnant women with SUD. These themes may help direct future studies and guide efforts to increase access to crucial care in this vulnerable population.

A pilot multisite study of patient navigation for pregnant women with opioid use disorder

The opioid crisis continues to affect pregnant and postpartum women the United States, with the number of pregnant women diagnosed with opioid use disorder (OUD) quadrupling over the last decade. The associated increase in morbidity and mortality among mother and baby warrants prompt, targeted intervention efforts that improve engagement, linkage of care, and treatment retention. Patient navigation (PN) is a chronic care intervention that can directly address this need by helping women identify medical, behavioral, and psychosocial care goals. Moreover, PN can assist women in preparing for, engaging in, and maintaining patient participation in necessary services. Specifically, PN includes strengths-based case management, 1-1 clinical support, motivational interviewing, and addiction-relapse prevention programming. The objective of this article is to present the study protocol of a pilot multisite randomized clinical trial, entitled: Optimizing Pregnancy and Treatment Interventions for Moms 2.0 (OPTI-Mom 2.0; NCT03833245). In this study, we build upon a proof-of-concept study, employing evidence-informed frameworks for protocol and intervention expansion in order to construct a PN intervention tailored for pregnant women with OUD in central Utah and southwestern Pennsylvania. Our protocol provides an initial framework of a potentially impactful intervention and may guide development of future programs. Importantly, this study further establishes the evidence-base-with potential to ameliorate serious adverse opioid-related outcomes and improve health for women and their children.

Opioid Use in Pregnancy

PURPOSE OF REVIEW

Perinatal opioid use is a major public health problem and is associated with a number of deleterious maternal and fetal effects. We review recent evidence of perinatal outcomes and treatment of opioid use disorder (OUD) during pregnancy.

RECENT FINDINGS

Opioid exposure in pregnancy is associated with multiple obstetric and neonatal adverse outcomes, with the most common being neonatal opioid withdrawal syndrome (NOWS). Treatment with buprenorphine or methadone is associated with NOWS, but neither medication appears to have significant adverse effects on early childhood development. Buprenorphine appears to be superior to methadone in terms of incidence and severity of NOWS in exposed infants. The long-term effects of opioid exposure in utero have been inconclusive, but recent longitudinal studies point to potential differences in brain morphology that may increase vulnerability to future stressors. Maintenance therapy with methadone or buprenorphine remains the standard of care for pregnant women with OUD given its consistent superiority to placebo in terms of rates of illicit drug use and pregnancy outcomes. New non-pharmacologic management options for NOWS appear promising. Future research is needed to further evaluate the effects of opioid exposure in utero and determine the optimal delivery model for maintenance therapy.