Among mothers with substance use disorder (SUD), most who likely need postpartum SUD treatment did not receive it, according to a recent study published in Women’s Health Reports. Mothers who received postpartum SUD treatment are more likely to have received prenatal SUD treatment, highlighting the connection between prenatal and postpartum SUD treatment.
The researchers conducted an observational study and used a sample of 1967 mother-infant dyads, in which the infant was diagnosed with neonatal abstinence syndrome (NAS) and/or prenatal substance exposure (PSE) in Louisiana, Massachusetts, and Wisconsin from 2006 to 2009. Those 3 states were used because overlapping data were available for the patient sample.
Data had been gathered from 2005 to 2009 for a study of pharmacotherapy for opioid use disorder (OUD) and included all women enrolled in Medicaid in the states. The data from 2005 provided information about the prenatal period for women who delivered in 2006.
The main outcome variable of the study was receiving postpartum SUD treatment within 60 days of delivery. This range of 60 days was chosen to ensure that the women in the study were all enrolled in Medicaid because before the Affordable Care Act, many women with limited resources lost coverage after 60 days.
Results of the study showed that of the mother-infant dyads, 15% received postpartum SUD treatment within 60 days following delivery, 42% of the mothers were diagnosed with SUD or OUD in the prenatal period, and 46% of all the mothers had a co-occurring mental health condition in the perinatal period. Only 1 in 5 mothers had received any prenatal SUD treatment.
In this study, mothers of infants with NAS and/or PSE who received postpartum SUD treatment and mothers who did not receive postpartum SUD treatment within 60 days were compared. The mothers who received postpartum SUD treatment were older (P =.03) and were more likely to be White and to reside in a large central or fringe metropolitan area (P <.001 for both comparisons).
SUD treatment also varied by state; of the mothers in the study who received postpartum SUD treatment, 58% resided in Wisconsin, 35% in Massachusetts, and only 7% in Louisiana.
Mothers in the study who received postpartum SUD treatment were more likely to have an OUD diagnosis (71% vs 17%) and a co-occurring mental health condition (65% vs 43%, P =.008).
In total, 68% of pregnant women who received postpartum SUD treatment had also received prenatal SUD treatment; only 12% of women who did not receive postpartum SUD treatment had received prenatal SUD treatment. In the first 60 days postpartum, 88% of mothers did not receive prenatal SUD treatment and had not received prenatal treatment (P <.001).
No statistically significant association was found between the timing of the postpartum SUD treatment and months of Medicaid enrollment before delivery or the number of prenatal or postpartum visits.
Some limitations of the study include possible misclassification of SUD, OUD, and/or the treatment episodes, and the lack of data for postpartum treatment past 60 days of delivery. The misclassification was mitigated by the researchers noting whether the mothers were taking methadone or buprenorphine, both of which were indicated for OUD treatment.
“We found that the vast majority of women who likely need SUD treatment did not receive it within 60 days postpartum,” the researchers stated.
According to the study research, it has become an increasingly difficult health challenge among pregnant and postpartum women with a history of substance use to get the treatment they need because most of the time, their substance use history is overlooked by health care providers. “Untreated SUDs lead to numerous adverse outcomes for mother–infant dyads,” the researchers added.
Underdiagnosis and undertreatment for mothers with SUD could lead to more complications for the mother and any future children as well.
Overall, these findings show that more health care policies focusing on maternal health should be implemented.
Faherty LJ, Heins S, Kranz AM, Stein BD. Postpartum treatment for substance use disorder among mothers of infants with neonatal abstinence syndrome and prenatal substance exposure. Womens Health Rep (New Rochelle). 2021;2(1):163-172. doi:10.1089/whr.2020.0128