(136) A Systematic Review of Interventions for Opioid Use Disorder during the First Year Postpartum

Opioid use disorder (OUD) is a leading cause of maternal mortality, particularly postpartum (PP). The objective of this systematic review is to provide a qualitative summary of published interventions for PP opioid abstinence or reduction.

Study Design: This systematic review was registered with PROSPERO (ID CRD42023405688). A comprehensive search of CINAHL, MEDLINE, PsycINFO, and EMBASE was conducted for intervention trials with ≥ 5 subjects aimed at opioid use reduction or abstinence in the first year PP. Studies without a comparison group or interventions continued PP were excluded. All abstracts were summarized, if eligible, by 2 independent reviewers. Risk of bias was assessed with the Cochrane Risk of Bias or Newcastle-Ottawa Scale.

Results: Of 812 articles screened, 14 were assessed for full-text eligibility and 3 were included for full-text review (Table). Study 1 assessed a therapeutic workplace (TW) that provided a job with reimbursement for opioid abstinence. Abstinence was increased in TW (n=20) compared to usual care (UC) (n=20) in the first 6 months PP, but the change was not significant (52% vs 33%, p=0.06). Study 2 assessed a comprehensive perinatal clinic’s effect on patients with substance use and demonstrated drug use abstinence during pregnancy in 93/97 (96%) of participants. However, only 10% of patients in the study had OUD, 22% were lost to follow up PP, and 13% relapsed to heavy drug use by 6 months PP. Study 3 compared motivational interviewing to UC in 60 participants and found a significant reduction in PP opioid use (23% vs 60%, p=0.004).

Conclusion:

Despite the large contribution of OUD to maternal mortality, only 3 intervention studies have assessed strategies to reduce opioid use PP. Existing studies vary widely in intervention type and effect. Our systematic review illustrates the paucity of evidence-based interventions for PP OUD. This underscores the pressing need to further address this significant public health concern and contributor to maternal mortality.