REVIEW OF: Mason I et al, J Addict Med 2022;16(4):420–424

STUDY TYPE: Retrospective cohort study

Optimizing opioid use disorder (OUD) treatment during pregnancy is of the utmost importance; in addition to the usual risks of overdose and death to the pregnant patient, untreated OUD risks preterm labor, intrauterine growth restriction, and fetal death. Co-locating obstetric and OUD care has been shown to improve outcomes, but how long these benefits last and whether they carry over into subsequent pregnancies is unknown (Meter M et al, J Addict Med 2012;6(2):124–130).

To find out, researchers performed a retrospective cohort study of 42 patients with a diagnosis of OUD who received care at their multidisciplinary obstetric and addiction clinic for more than one pregnancy. The clinic provided prenatal care, initiation and management of buprenorphine and methadone, and weekly group therapy, as well as access to a team of social workers, psychiatrists, counselors, and nurses. The primary outcome was rate of medication for OUD (MOUD) at the first pregnancy compared to subsequent pregnancies. Secondary outcomes were rate of neonatal opioid withdrawal syndrome (NOWS) and length of hospital stay.

The results clearly showed that remaining in interdisciplinary care was associated with improved OUD outcomes in subsequent pregnancies. Participants were six times more likely to be on MOUD treatment before subsequent pregnancy as compared to their first pregnancy (odds ratio [OR]=6.48 [95% confidence interval (CI), 2.52–16.64]). Unsurprisingly, the improved MOUD adherence also resulted in lower rates of prenatal urine drug screens positive for illicit substances (64% vs 36%, OR 0.33 [95% CI, 0.14–0.78]). Other outcomes, such as rates of NOWS, length of hospital stay, and involvement of child protective services, were not significantly different.

The findings are compelling, though the study’s small cohort is a major limitation. And the authors acknowledge that future studies should utilize neonatal outcomes other than NOWS, which is expected from intrauterine exposure to both MOUD and illicit opioids. Finally, receiving obstetric and OUD care from separate providers is the norm; however, authors did not compare their findings with those of patients receiving care separately. We therefore don’t know how much benefit patients derived from co-locating these services versus accessing them separately.

CARLAT TAKE 

Good peripartum OUD treatment is associated with better outcomes. This study shows, albeit with a small sample size, that good OUD treatment during a first pregnancy can carry into improved outcomes in subsequent pregnancies. Our goal should be to continue to aggressively treat OUD in pregnant patients and do what we can to help them remain in treatment.

For more on this topic, see Frequently Overlooked Considerations in Women's Mental Health (webinar).