Individuals With Opioid Use Disorder in the Perinatal Period: Characteristics and Engagement in Integrated Treatment.

Abstract

The objectives of the study were to describe an integrated screening, brief intervention, treatment and referral (SBIRT) prenatal care program for opioid use disorder (OUD), factors influencing program engagement, and the characteristics of pregnant and postpartum people with OUD. This was a retrospective cohort study of 245 pregnant and postpartum people with OUD who had access to a 30-day SBIRT program at a safety-net hospital between March 15, 2021, and March 15, 2024. Multivariable logistic regression models assessed predictors of program completion, defined as engaging in 4 weekly outpatient visits. Forty-two percent of participants completed the program, and 86% received medication for opioid use disorder (MOUD). Factors that increased the likelihood of program completion included entry through referral versus the emergency department (OR: 3.05, 95% CI: 1.58-6.04), family history of SUD (OR: 2.28, 95% CI: 1.31-4.01), and comorbid psychiatric diagnosis (OR: 1.87, 95% CI: 1.04-3.39). The use of multiple substances (OR: 0.43, 95% CI: 0.19-0.92) and positive fentanyl screens (OR: 0.26, 95% CI: 0.12-0.55) decreased the likelihood of program completion. Neither trimester of pregnancy nor severity of OUD influenced program completion. Social determinants of health were common. An SBIRT program offering 24-hour coverage with skilled providers offering trauma-informed care and social supports integrated with prenatal care results in high engagement and acceptance of MOUD. Policy implications support improved access to naloxone, fentanyl testing strips, and maternity housing. Results suggest further research into the specific nature of how family history of SUD improves engagement in treatment programs.