Clinical Report: Strategies for Managing Opioid Use Disorder in Pregnant Individuals

Overview

This scoping review identified 31 intervention studies addressing opioid use disorder (OUD) during pregnancy in the U.S. Interventions varied across individual, interpersonal, and community levels, emphasizing medication for opioid use disorder (MOUD) access and broader social determinants to improve maternal health outcomes.

Background

Opioid use disorder during pregnancy has more than doubled in the U.S. from 2010 to 2017, posing significant risks to maternal and neonatal health. Evidence-based care includes behavioral therapies combined with MOUD, such as buprenorphine or methadone, which reduce overdose risk and improve outcomes. Despite this, barriers to MOUD access and adherence remain substantial. Pregnancy offers a critical window to identify and treat OUD while addressing co-occurring health and social needs.

Data Highlights

A total of 31 intervention studies were included after screening 1,381 articles. Of these, 45% had predominantly non-Hispanic white participants. Interventions were categorized by socioecological model levels: 55% individual-level, 19% interpersonal-level, and 26% community/society-level. Individual interventions focused on clinical care coordination, MOUD detoxification/tapering, and prenatal education. Interpersonal interventions included clinician education and group therapy. Community-level efforts targeted regional service coordination, while societal-level studies examined policy impacts on MOUD access.

Key Findings

• MOUD remains a cornerstone of effective prenatal OUD treatment, reducing maternal overdose and improving health outcomes.
• Individual-level interventions often involve coordinated clinical care models and prenatal education to support treatment adherence.
• Interpersonal interventions such as clinician education and group therapy can enhance support networks and treatment engagement.
• Community and societal interventions addressing social determinants and policy barriers show promise for broader impact on MOUD access and maternal health.
• Most studies included predominantly non-Hispanic white populations, highlighting a need for more diverse research.
• Multi-level approaches integrating clinical, social, and policy strategies are critical for improving outcomes in pregnant individuals with OUD.

Clinical Implications

Clinicians should prioritize MOUD access and adherence during pregnancy while incorporating coordinated care and prenatal education. Expanding interventions to include clinician training and group therapy may enhance support. Addressing social determinants and advocating for policy changes at community and societal levels can further improve maternal health outcomes. Tailoring interventions to diverse populations is essential to reduce disparities.

Conclusion

This review highlights a spectrum of prenatal OUD interventions across multiple socioecological levels, underscoring the importance of integrated approaches. Enhancing MOUD access alongside community and policy initiatives may yield the greatest improvements in maternal and neonatal health.

References

1. Mak and Thomas 2023 -- Strategies for Managing Opioid Use Disorder in Pregnant Individuals: A Scoping Review