(79) Postpartum Interpersonal Violence among Individuals with Opioid Use Disorder

Background &

Introduction: Postpartum relapse and overdose among individuals with Opioid Use Disorder (OUD) is now a leading causes of maternal mortality nationwide. Women with OUD are also at increased lifetime risk of experiencing interpersonal violence (IPV) which often increases during pregnancy. However, no studies have examined IPV longitudinally throughout the first year postpartum.

IPV encompasses physical, sexual, economic and emotional abuse. Several studies have examined these individual aspects of IPV among individuals with OUD in the early postpartum period. Morrison and colleagues found that providers caring for individuals with OUD were significantly limited in their ability to aid patients seeking help for IPV due to ineffective screening, limited resources for patients, and provider bias. Martin and colleagues also found that individuals reporting IPV were more likely to experience homelessness, relapse, and mental health emergencies. These results were confirmed by a large community survey in Canada which found that among those reporting IPV, there was an increased risk of developing significant postpartum mood disorders.

This study seeks to fill the gap in identifying patterns of IPV and associated OUD factors for individuals with OUD throughout the first year postpartum including return to illicit substance use and remaining active in an OUD treatment program.

Methods: This was a secondary data analysis from a prospective observational study that was conducted between May 2016 and July 2018 at large teaching hospital in Southwestern Pennsylvania. Participants who met DSM-5 criteria for OUD and were at least 18 years of age were approached and recruited during their postpartum hospital stay and remained in the study for one year. Study participants were e-mailed surveys at 3, 6, 9, and 12 months postpartum with questions on return to illicit substance use, key stressors in their lives, IPV such as whether they felt safe at home, experienced conflict with their partners, or reported contraceptive coercion. Participants were asked at each time point if their partners were a source of stress since the last survey and also if they were a source of support. They were also asked about contact with their partners at each time point, regular contact was classified as every day or most days. Participants were also asked about regular conflict with their partner, regular conflict was classified as always, often or sometimes.
Descriptive statistics were used for analysis. Demographic data, appointment attendance, and substance use history were gathered from the electronic medical record (EMR).

Results: For this secondary analysis, participants were included who completed their baseline surveys (n=194). Table 1 provides an overview of demographic and substance use data for participants including age, race, insurance, income, marital status, and social determinants of health: education, transportation, and housing. Of note, 21% (n=41) reported homelessness in the year prior to delivery.

At 3 months postpartum, 99.5% (n=193) of participants reported feeling safe at home which steadily declined to 60.8% at 12 months (n=118). Regular contact with their partner at the time of delivery, defined by seeing them every day or most days, decreased from the time of birth (n=176, 90.7%) to 12 months postpartum (n=98, 50.5%). Regular conflict with partners (identified by participants as conflict occurring always, often, or sometimes), as well as partners being identified as a source of support, and partners as a source of stress remained relatively constant from time of delivery to 12 months postpartum.

In Table 3, longitudinal data of history and concurrent partner abuse is depicted including high lifetime number of participants reporting ever ending a relationship because it felt unhealthy (n=120, 61.9%), experiencing sexual trauma (n=100, 51.5%), partner stalking (n=96, 49.5%), and physical abuse (n=78, 40.2%). The number of participants reporting these experiences throughout the first year postpartum remained relatively stable from 3 to 12 months.

Table 4 shows the number of participants who returned to illicit substance use within the first 3, 6, 9, and 12 months postpartum. Participants who remained in active treatment for their OUD throughout the first year postpartum significantly decreased from 3 months (n=124, 71.5%) to 12 months postpartum (n=40, 33.1%).
Conclusion & Discussion: This study demonstrates the continued presence and possible increase of IPV for indviduals with OUD throughout the first year postpartum. Comparitively, there is a relative downward trend of IPV from the time of birth through the end of the first year postpartum in the general population. Participants in this study reported feeling less safe at home at 12 months postpartum than at the time of delivery along with decreased partner contact and increased partner-related stress.
Healthcare professionals caring for individuals with OUD should be aware that IPV may worsen in the first year postpartum leading to an increased need for screening, support, and referrals for needed services. Morrison and colleagues recommend approaching patients with OUD with a trauma informed perspective in order to increase the number of patients who feel comfortable disclosing IPV and seeking support.
Future research should focus on what individuals with OUD experiencing IPV in the first-year postpartum need in order to maximize the health and wellbeing of their family such as access to safe housing, transportation, and peer support.
The main study limitation was the number of participants who failed to respond to study surveys as the study year went on.
Rererences

1. Mangla, K., et al., Maternal self-harm deaths: an unrecognized and preventable outcome. American journal of obstetrics and gynecology, 2019. 221(4): p. 295-303.
2. Krans, E.E., et al., National Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder. Obstetrics and gynecology (New York. 1953), 2019. 134(2): p. 365-375.
3. Wen, T., et al., Postpartum Readmissions Among Women With Opioid Use Disorder. Obstetric anesthesia digest, 2020. 40(1): p. 10-10.
4. Morrison, P.K., et al., Co-occurring Substance use and Intimate Partner Violence in Pregnant and Postpartum Women: A Systematic Literature Review. Journal of family violence, 2023.
5. Peacock-Chambers, E., et al., Engagement in perinatal outpatient services among women in recovery from opioid use disorders. Substance abuse, 2021. 42(4): p. 1022-1029.