Addiction treatment in the postpartum period: an opportunity for evidence-based personalized medicine

Abstract

Substance use disorders (SUD) are becoming rapidly more prevalent in women and a leading cause of pregnancy associated deaths, with most deaths occurring during the 12 months after pregnancy. The postpartum period can be quite intense, especially for women seeking addiction recovery. There is a call to reconceptualize the obstetrical postpartum care model into one that extends specialised care and is tailored to an individual's specific needs. Although SUD treatment improves maternal and infant outcomes as well as decreases overdose risk, many women do not receive consistent SUD treatment during the postpartum period. Thus, SUD treatments should consider following the same guidance as obstetrics to reconceptualize how SUD treatment is delivered postpartum. Clinically, this translates into substantially modifying traditional siloed SUD treatment structures to meet the unique needs of this vulnerable patient population. At the same time, more research is urgently needed to inform these advancements in clinical care to ensure they are evidence-based and effective. In this article, we review the existing evidence as well as highlight opportunities for both clinicians and researchers to advance the integration of tailored approaches for postpartum women into personalised SUD medical and behavioural treatments.

An Integrated Care Model for Pregnant and Postpartum Individuals Receiving Medication for Opioid Use Disorder

“…21 Patients tend to be more engaged with treatment and more willing to re-engage after treatment gaps when their recovery plan is flexible and designed around their psychosocial needs. 20,21 More research among larger samples is needed to identify evidence-based methods to individualize integrated obstetric/addiction care to support recovery in the postpartum period.…”

“…However, the ideal combination of those services has yet to be described. 20 Thus, a critical first step in this investigation is to evaluate which care components within an integrated care model pregnant and postpartum people utilize and how OUD treatment outcomes vary by voluntary service utilization in an outpatient setting. 20,21 To our knowledge, no studies have assessed the association of service utilization during the pregnancy-to-postpartum transition with postpartum buprenorphine continuation.…”

“…Within integrated care, increasing the number of services used by patients does not translate into better outcomes. This so-called kitchen-sink approach to service provision may be a barrier to retention in treatment 20 . Prior research suggests that requiring patients to utilize all available services to be eligible to receive OUD treatment may not be effective in the ever-changing and stressful postpartum period 5 .…”

Project BETTER: Preliminary Feasibility and Acceptability of a Technology-Delivered Educational Program for Pregnant and Postpartum People with Opioid Use Disorder

“…There is an urgent need for evidence-based, clinically feasible educational tools that can effectively equip the parent–infant dyad affected by OUD for continued recovery and optimal long-term outcomes. 13 While NOWS education has been a component of broader parenting programs, 14 only one study has reported on an educational intervention specific to NOWS for pregnant people in treatment for OUD. 15 Although this study did not find a significant change in knowledge from baseline to post-education, participants indicated that the intervention was helpful in preparing them for the early postpartum period, while their newborns were hospitalized.…”

Commentary on Nowakowski et al.: Bringing the participants’ own words into addictions research—a win–win for patients and investigators

“…In the ongoing overdose crisis, there is a call to advance the use of precision medicine in addiction treatment settings [14], yet the evidence base to guide data-driven efforts to address this need is lacking, especially in pregnancy and postpartum [15]. Studies incorporating qualitative methods can be a powerful tool to elucidate nuances of the patient perspective and an individual's socio-cultural context that can be lost when limited to quantitative measurements.…”