(77) Maternal and Neonatal Outcomes in an Integrated Substance Use Disorder Treatment Program

Background & Introduction: Substance use disorder (SUD) in pregnancy is associated with adverse obstetric and neonatal outcomes, and SUD treatment may reduce these likelihoods. However, pregnant individuals are less likely to engage in SUD treatment because of increased stigma and other barriers. Integrating SUD treatment with prenatal care may improve outcomes. Individuals with SUD at our safety-net hospital received treatment and recovery services by a multidisciplinary care team (MCT) including addiction medicine physicians, licensed chemical dependency counselors (LCDC), peer recovery navigators, and SUD-trained certified nurse midwives under the supervision of maternal-fetal medicine (MFM) faculty. This team provided in-person SUD related consultations Monday-Friday for pregnant individuals in inpatient and high acuity or emergency department areas, coordinated prenatal SUD care with MFM in a weekly specialty prenatal clinic, and conducted postpartum buprenorphine induction visits. The objectives of this study were to describe the services provided by a multidisciplinary care team at a public hospital system caring for pregnant individuals with SUD, and to evaluate retention to delivery in individuals with and without engagement in SUD care.

Methods: This is a retrospective cohort study of pregnant patients with substance use disorder (SUD) who accessed care at a safety-net hospital system between July 28, 2021 and June 25, 2022. Patients with SUD were identified by universal screening, maternal and neonatal ICD-10 codes (F11.XX for maternal codes, and P96.1, P04.49, or P04.14 for neonates), and SUD was verified by electronic health record (EHR) review. Demographic and social history data was collected. Data on multidisciplinary care team session setting (ambulatory vs inpatient), provider type (addiction medicine physician or SUD-trained midwife provider vs LCDC), individual versus group therapy session, and therapy type (behavioral vs medication for addiction treatment) was collected from the EHR. We compared rates of delivery at our institution among those with and without engagement with our MCT. Data are reported as n[%] and categorical variables were compared using the chi square test. A p value of < 0.05 was considered significant.

Results: Among 256 pregnant individuals with substance use disorder (SUD) who accessed care in our system, 140 (55%) individuals had psychiatric comorbidities and 82 (32%) individuals reported a history of trauma in their lives. 35 (14%) individuals were incarcerated and 34 (13%) experienced homelessness during pregnancy. Of 256 individuals, 144 (56%) received care by our MCT during pregnancy or at the delivery hospitalization. Compared to those not seen by our team, individuals who were seen by our MCT were more likely to use opiates as drug of choice (80[55%] vs 16[14%], p<0.001) and less likely to use cannabis as drug of choice (24[16%] vs 40[36%], p<0.001). Of 144 individuals who received care with our team, 48 (33%) received care in ambulatory settings only, 44 (31%) received care in inpatient settings only, and 52 (36%) received care in both ambulatory and inpatient settings. Among 144 with MCT care, 127 (88%) patients received care by an addiction medicine physician or SUD-trained midwife provider, and 119 (83%) by a licensed chemical dependency counselor. 143 (99%) patients received individual counseling sessions and 29 (20%) participated in group therapy sessions. Of 144 individuals, 142 (99%) received behavioral health therapy. Of 105 individuals with opioid use disorder, alcohol use disorder, or benzodiazepine use disorder seen by our MCT, medication for addiction treatment was received from our team by 85 (81%). Among 256 individuals with SUD, delivery at our institution was more frequent among those who engaged with our MCT team (98 of 144 [68%] MCT patients vs 41 of 112 [37%] non-MCT patients, p<0.001).

Conclusion & Discussion: Substance use treatment and recovery services integrated with prenatal care throughout ambulatory and inpatient settings may be linked to better retention of individuals through delivery, facilitating continuity of treatment and recovery services postpartum. Barriers may prevent almost half of individuals with SUD in pregnancy to receive services before delivery. More study is needed to determine how to augment and optimize services to better reach these individuals and retain them through delivery.

References: Oni HT, Buultjens M, Mohamed AL, Islam MM. Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data. Subst Use Misuse. 2022;57(1):1-10. doi:10.1080/10826084.2021.1958851

Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. N Engl J Med. Dec 1 2022;387(22):2033-2044. doi:10.1056/NEJMoa2203318

Sweeney PJ, Schwartz RM, Mattis NG, Vohr B. The effect of integrating substance abuse treatment with prenatal care on birth outcome. J Perinatol. Jun 2000;20(4):219-24. doi:10.1038/sj.jp.7200357