Navigating pregnancy and addiction recovery: Patient perspectives on perinatal care interventions for women with opioid use disorder in Kentucky, USA.

BACKGROUND AND

aimsThe state of Kentucky has been heavily impacted by the ongoing opioid crisis in the United States, with high overdose mortality, high prevalence of opioid use disorder (OUD), elevated maternal mortality and incidence of Neonatal Abstinence Syndrome. Evidence-based care for pregnant people with OUD remains limited in many areas of the state, and patient perspectives are urgently needed to understand the acceptability of intervention approaches, and broader perspectives on prenatal and recovery care in their communities. This study aimed to understand women's experiences with prenatal care and substance use treatment in Kentucky throughout the perinatal period.

designData were drawn from a recently completed Patient-Centered Outcomes Research Institute (PCORI) funded comparative effectiveness trial known as PATHHome, whose overarching objective was to study the delivery of a pregnancy-specific educational recovery curriculum for pregnant women treated for OUD in Kentucky. PATHHome was a pragmatic, non-inferiority, cluster randomized trial testing group versus telemedicine interventions for delivering care. We conducted a qualitative study with trial completers.

settingPATHHome was conducted in 13 clinical sites across eastern and central Kentucky.

participantsEligible patient participants were: (1) between ages 18-55, (2) pregnant (between 6 and 32 weeks' gestation), (3) diagnosed with OUD, and (4) being treated with medications for opioid use disorder (MOUD). Thirty-three participants across 10 clinical sites were ultimately interviewed. MEASUREMENTS: Participants were invited to complete an in-depth qualitative interview at the time of their final 6-month postpartum follow-up visit. Interview coding was conducted using a hybrid inductive-deductive approach and consensus coding techniques were used. Coding and analysis were conducted in NVivo.

findingsSystematic analysis of patient experiences revealed four overarching themes: Theme 1. MOUD stigma diminishes the quality of perinatal care for women with OUD, highlighting the need for expanded integration of evidence-based MOUD, prenatal and delivery care; Theme 2. Navigating siloed and inconsistent care system policies contributes to suboptimal delivery experiences and limits parenting opportunities; Theme 3. Maternal engagement in perinatal OUD interventions is enhanced by responsive and adaptable approaches that address patient beliefs, circumstances and histories; and Theme 4. A pregnancy-specific educational recovery curriculum delivered by a supportive, nonjudgmental and multidisciplinary intervention team promotes high acceptability among women on MOUD.

conclusionsIn Kentucky, USA, there appears to be a high level of acceptability for a pregnancy-specific opioid use disorder recovery education intervention among pregnant patients on medications for opioid use disorder (MOUD). Major recommendations include prioritizing the expansion of integrated prenatal and addiction care, including through the use of telehealth in communities with insufficient clinical capacity, and engaging the entire perinatal healthcare team in stigma training and foundational training on MOUD, which may reduce episodes of enacted stigma in the care setting.