Neonatal outcomes of pregnant women attending integrated and standard substance use treatment programs in Ontario, Canada

Abstract

BackgroundSubstance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data.MethodWe conducted a population‐based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada.ResultsNeonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type.ConclusionFindings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long‐term service models that support women and children beyond the perinatal and early childhood periods.

Programs and practices that support pregnant people who use drugs’ access to sexual and reproductive health care in Canada: a scoping review

“…Some offered healthcare including access to in-patient treatment programs (n = 18) (for example see [62,115,117]) and few also offered opioid agonist treatment (OAT) onsite (n = 5) (for example see [71,80]). Other common forms of harm reduction and treatment support included individual recovery planning (n = 17) (for example see [66,131]), group education (n = 14) (for example see [76,79,101]), and general harm reduction support (n = 12) (for example see [67,81,118]).…”

“…The most common practices used by service providers included non-judgmental care (n = 13) (for example see [62,98,133]), communitybased support (n = 12) (for example see [117,125]), harm-reduction strategies (n = 12) (for example see [108,123,133]) and trauma-informed care (n = 11) (for example see [86,114]). Many of the practices adopted work to reduce barriers to services for PPWUD and include collaboration between service providers (n = 8) (for example see [76,117]), accessible childcare (n = 6) (for example see [75,134]) and home visits (n = 3) [119,131]. Culturally informed care (n = 9) (for example see [63,98]) was noted, with several programs working with Indigenous elders and community members to integrate cultural practices, such as smudging, ceremonies and prayer into wellbeing and rehabilitation activities.…”

“…Out of the 71 articles, 21 specifically reported challenges identified within the programs. Specific to service providers and resources, issues related to tensions between service providers (n = 4) (for example see [90,133]), staff and service provider shortages (n = 3) [65,96], limited group sessions (n = 1) [131], limited one-on-one sessions (n = 1) [131], program length restrictions (n = 1) [131], limited partnerships with service providers (n = 1) [131], limited physical space (n = 1) [131], limited options for home visitations (n = 1) [119], limited funding (n = 1) [65] and limited accessible locations (n = 2) [131,132] were reported. Overarching these challenges is funding and without sufficient capital, programs that support vulnerable groups, particularly operated by non-profit organisations, are limited in the support and resources they can offer.…”

“…Lastly, it was reported that there is a lack of tailored support for men (n = 1) [128] and youth (n = 1) [128], variability in addressing other barriers to care (i.e. transportation, childcare) (n = 3) [131,132], a need to tackle misinformation about pregnancy (n = 1) [106] and nation-wide variations in how data are collected (n = 1) [128].…”

“…prenatal, perinatal, and postpartum), including parenting supports and positive child health outcomes (n = 31). The multifaceted needs of PPWUD were addressed by many of these programs through offering social services (e.g., housing, employment, child and family services) (n = 18)[63,75,78,84,89,93,97,99,104, 106, 108, 112,116,119,130,131] within the program or offering referrals, advocacy, and accompaniment to external services. A few programs specifically offered wrap-around services (n = 6)[65,66,71,86,90] including treatment services and personal support services, with two (n = 2) programs specifically supporting homeless pregnant people[82,123].…”