Identifying Psychosocial Risk Factors in Maternal Substance Use in Western Pennsylvania

Background/Significance:

Over the past decade, rates of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) have increased dramatically, with estimates of a rise by 131% from 2010 to 2017. (Hirai et al. 2021). Pregnancy and the post-partum period increase the frequency of encounters with medical care providing an opportunity for consultation-liaison (CL) psychiatrists to discuss medications for OUD (MOUDs), benefitting both the pregnant person and their child (Mascola et al. 2017). As CL psychiatry expands service access via telehealth to rural hospitals, providers must understand regional considerations associated with maternal OUDs. Insufficient information regarding the psychosocial characteristics of these individuals limit the ability to create tailored intervention programs. The purpose of this study is to fill this knowledge gap through a county-wide needs assessment to inform integrated care practices.

Methods: Data were collected in rural Erie and Venango counties in Pennsylvania to assess the impact of OUD on parents and families. Pregnant and postpartum individuals within one year of giving birth with active opioid use were recruited from community outpatient clinics and contacted via telephone after consent to participate in a focus group for a community needs assessment. Individual characteristics were analyzed via descriptive statistics.

Results: Data collection occurred over 25 participants; 14 (56%) were pregnant at time of enrollment and 11 (44%) were postpartum. Of the pregnant participants, 43% were in the first trimester, 29% in the second, and 29% in the third trimester. Average age was 31.2 years (SD 5.8 years). The majority had Medicaid (64%). Average number of children already in the home was 2 (SD 1.07). State Child, Youth and Family Services (CYF) were involved with 8 (32%) individuals. 24% of participants reported infants with neonatal intensive care unit (NICU) admission and 20% reported NAS. At time of enrollment, 16 (64%) of participants were on MOUDs (buprenorphine/naloxone or buprenorphine; dose range 4mg-20mg daily). 68% identified opioids as their substance of choice; the remainder identified stimulants (16%), alcohol (12%), and cannabis (4%). Of the 84% of participants who identified a secondary substance, the most common were stimulants (i.e., methamphetamine and cocaine) at 75% and cannabis at 14%.

Implications: For pregnant and postpartum individuals in rural western Pennsylvania with substance use, significant psychosocial challenges include high rates of CYF involvement, removal of children from the home, and financial difficulties. Our institution has addressed this by creating a multidisciplinary integrated care MOUD peripartum clinic including a telepsychiatry component and medical hospital coordination through CL psychiatry. Further research is needed to clarify whether CL telepsychiatry programs may increase engagement and retention.

References:

Hirai, A. H., Ko, J. Y., Owens, P. L., Stocks, C., & Patrick, S. W. (2021). Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA, 325(2), 146–155. https://doi.org/10.1001/jama.2020.24991

Maria A. Mascola, MD, MPH, Ann E. Borders, MD, MSc, MPH, & Mishka Terplan, MD, MPH. (2017). Opioid Use and Opioid Use Disorder in Pregnancy. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Opinion, 711.