(37) Impact of Integrated Substance Use and Obstetric Care on Delivery Outcomes

Background & Introduction: Substance use during pregnancy places the maternal-infant dyad at high risk of adverse health outcomes. Comprehensive and timely treatment can attenuate these risks. Although often offered separately, pregnancy represents a unique opportunity to provide substance use treatment alongside recommended obstetric services as part of an integrated care package. However, little is known about the incremental impact of combining substance use and obstetric care (i.e., integrated care). The objective of this study was to determine whether integrated care provides a significant health benefit for preterm birth, birthweight, and other maternal-neonatal outcomes over non-integrated care approaches among perinatal individuals with opioid use.

Methods: We conducted a survey of postpartum individuals with self-reported opioid use, aged 18+, and residing in Western North Carolina to inquire about their prenatal care, substance use care, and their health outcomes (maternal and neonatal). We specifically examined gestational age, birthweight, cesarean delivery, urine toxicology testing, neonatal intensive care unit (NICU) admission, and requiring treatment for neonatal opioid withdrawal syndrome (NOWS). Individuals receiving substance use treatment at the same clinical office as their obstetric care were classified as receiving integrated care. All others were considered non-integrated. Survey responses were collected from October 2020 through June 2024. Descriptive statistics characterized the survey participants and their responses. Chi-square and Mann-Whitney U tests determined whether there were significant differences between the two groups. This study was reviewed and deemed exempt by the Mission Hospital Institutional Review Board.

Results: We received a total of 57 eligible responses, 47 (82%) of whom indicated receiving integrated care and the remaining 10 (18%) not receiving integrated care. All participants identified as women, the average (standard deviation) age was 29 (4.1), 91% had Medicaid insurance during pregnancy, 85% reported having earned at least a high school diploma, 74% reported having anxiety or depression, and 55% reported having a diagnosis of another substance use disorder. Participants were on average 8 months postpartum from their most recent delivery.
Across the outcomes examined, there was a statistically significant difference in the birthweight between the two groups, with those receiving integrated care having infants weighing on average 220 grams more as compared to those not receiving integrated care (p < 0.05). Individuals receiving integrated care also reported significantly higher levels of understanding about toxicology screenings performed (p < 0.05). Finally, participants who received integrated care initiated breastfeeding at significantly higher rates (83% vs 50%, p < 0.05).
Although not statistically significant, participants receiving integrated care reported lower rates of preterm birth (13% vs 30%), low birthweight (7% vs 10%), neonatal treatment for NOWS (25% vs 47%), but higher rates of NICU admissions (67% vs 50%) and Cesarean delivery (42% vs 30%) as compared to individuals receiving non-integrated care.

Conclusion & Discussion: Integrated substance use and obstetric care may offer some incremental benefits to the maternal-infant dyad over non-integrated care, particularly as it relates to preventing low-birthweight, improving patient education and understanding of upcoming procedures, and promoting breastfeeding initiation. The data presented are limited as they represent one region in North Carolina. The findings may also be impacted by the reliance on self-reports and the limited responses for non-integrated care. Larger, more representative datasets are needed to explore the findings herein and other relationships further.

References: Goodman DJ, Saunders EC, Frew JR, Arsan C, Xie H, Bonasia KL, Flanagan VA, Lord SE, Brunette MF. Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort study. Am J Obstet Gynecol MFM. 2022 Jan;4(1):100489. doi: 10.1016/j.ajogmf.2021.100489. Epub 2021 Sep 17. PMID: 34543754.

Wouk K, Caton L, Bass R, Ali B, Cody T, Jones EP, Caron O, Luseno W, Ramage M. Patient navigation for perinatal substance use disorder treatment: A systematic review. Drug Alcohol Depend. 2024 Jul 1;260:111324. doi: 10.1016/j.drugalcdep.2024.111324. Epub 2024 May 8. PMID: 38761697.

Ellis LP, Parlier-Ahmad AB, Scheikl M, Martin CE. An Integrated Care Model for Pregnant and Postpartum Individuals Receiving Medication for Opioid Use Disorder. J Addict Med. 2023 Mar-Apr 01;17(2):131-139. doi: 10.1097/ADM.0000000000001052. Epub 2022 Aug 17. PMID: 35972153; PMCID: PMC9931937.