Perinatal Insights Into Parenting, Pathways, and Addiction (PIPPA): Protocol for a Longitudinal, Strengths-Based Study in Flanders, Belgium.

Background: Perinatal substance use is a growing global health concern with significant risks for maternal health, child development, and parenting. Despite these risks, the perinatal period offers a "window of opportunity" for behavioral change and recovery initiation. However, research exploring how vulnerability and transformation interact in the context of perinatal substance use remains scarce. Existing studies are predominantly cross-sectional, deficit-oriented, and focused on relapse or the medical effects of prenatal exposure, leaving critical gaps in understanding maternal trajectories and psychosocial factors shaping the transition to parenthood. Objective: The PIPPA (Perinatal Insights into Parenting, Pathways, and Addiction) study identifies the maternal, psychosocial, and contextual factors associated with whether the perinatal period becomes a promising or challenging transition to parenthood for women with substance use problems. Specific outcomes include trajectories of maternal mental health, recovery capital, substance use patterns, mother-child relationship quality, parental stress, and contextual conditions, as well as custody and cohabitation outcomes. An important focus is how these factors shape short- and long-term maternal and child trajectories. Methods: PIPPA is a longitudinal, prospective, multicenter, mixed methods study in Flanders, Belgium (May 2025-November 2026). Fifty pregnant and parenting women with alcohol and/or other substance use problems are recruited through obstetric departments, general substance use services, specialized substance use services, child protection services, and social media. Participants are assessed at 2-3 points: during pregnancy, 2-6 weeks postpartum, and 6 months postpartum. Data are collected using validated questionnaires (Alcohol Use Disorder Identification Test-Consumption, Drug Use Disorder Identification Test-Consumption, Edinburgh Postnatal Depression Scale, Satisfaction with Life Scale, Brief Assessment of Recovery Capital-10, Maternal Antenatal Attachment Scale, Maternal Postnatal Attachment Scale, and Parental Stress Scale) and custom instruments. Qualitative data include Three-Minute and Five-Minute Speech Sample tasks to assess maternal representations and expressed emotion, and semistructured interviews with pregnant and parenting women and caregivers. Quantitative analyses will include descriptive, longitudinal, subgroup, and regression models, while qualitative analyses will include longitudinal thematic analysis and structured coding of expressed emotion. All data are managed in REDCap (Research Electronic Data Capture). Results: Recruitment began in May 2025 and is expected to be complete in November 2026. Data collection began in June 2025. As of April 2026, 13 participants have been recruited. Data analysis will be performed after data collection. The results are expected to be published by the end of 2027. Conclusions: This study will contribute to a more strengths-based and evidence-informed understanding of the transition to motherhood in the context of perinatal substance use. The PIPPA study will capture diverse experiences and the complex interplay among substance use, recovery, and early parenting. These insights will inform and strengthen integrated, responsive early interventions to support pregnant and parenting women with substance use problems and promote child well-being.