A Scoping Review of Maternal Substance Use and Peer Support and Its Implications for Maternal Health Providers.

Abstract

The number of pregnant and postpartum women with opioid use disorder (PPWOUD) quadrupled since 1999, signifying a public health crisis. This scoping review examined the strength and consistency of findings in medical and social science literature regarding maternal recovery, capacity, and mortality from overdose, and the influence of recovery peer support specialists (RPSS). Study designs included clinical trials, cohort studies, case reports, case series, historical controls, and qualitative research and encompassed quantitative, qualitative, and mixed-methods studies. Excluded were studies with medication as the sole treatment for OUD, neonatal outcomes only, mortality specific to self-harm, and studies based outside the United States. Five authors independently evaluated inclusion criteria, extracted data, and assessed quality. PubMed, CINAHL, OneSearch, Clinicaltrials.gov, WHO, Embase, and Cochrane Review were searched from January 2000 to August 2021, with results reviewed between June and August 2021. Diverse study designs were used (observational cohorts, retrospective and prospective cohorts, cross-sectional studies, randomized trial protocols, and systematic reviews) across quantitative, qualitative, and mixed-methods approaches, organizing them within an eco-systems framework spanning pregnancy through 12 months postpartum to assess maternal recovery, capacity, and opioid-related mortality (Aims 1-3) and to contextualize these outcomes within the broader public health crisis and potential role of RPSS (Aim 4). Demographics, covariates, sources of bias, and effect size were compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) statement. Fourteen studies met inclusion criteria with the eco-systems framework. Aim 1, maternal recovery: early medication for OUD and mental health disorders, patient navigator, and RPSS had positive outcomes. Aim 2, maternal capacity: parental support was impactful, with external stigma and separation from their child having a negative impact. Aim 3, maternal mortality from opioid overdose: infant removal and untreated mental health were contributing factors. Aim 4, perceived effectiveness of RPSS: RPSS may support maternal recovery and capacity and reduce mortality from overdose, albeit the paucity of research. RPSS positioned to support PPWOUD may aid in effectively addressing this public health concern. Incorporating anti-oppressive practices and promoting agency for PPWOUD would increase access to services. Recommendations are to invest in research on recovery, emphasizing mental health, early treatment, and peer support to help coordinate and facilitate mental health services. In the 21st century, the number of women dying from opioid overdose in the United States more than quadrupled! Suicide and overdose are the leading causes of pregnancy‐related deaths. Cultural bias, oppression, and unmet mental health needs can make it very difficult to bring care to these women. We wanted to see what research had been done concerning women with opioid use on their recovery, caring for their infant, and deaths from overdose. An important kind of support can come from others who have gone through similar experiences and have been trained to walk alongside these women. That was also included in our search. We limited studies to those done in the United States. Studies included: clinical trials, cohort studies, case reports, case series, historical controls, and qualitative research. We excluded studies with: medication as the only treatment option, neonatal outcomes only, psychiatric self‐harm as cause of death. We searched through seven recommended databases, looking at medical and social science studies. We used the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for Scoping Reviews (PRISMA‐ScR) statement for charting. Of 13,800 potential articles, only 14 shed any significant light on how pregnant women with opioid use might be aided. Early help with opioid use and mental health struggles led to good effects from peer support. Support for parents aided in a mother's ability to care for her infant. But when the mother experienced societal judgment or the child was taken away, there were negative consequences. Mothers whose infant was removed or who did not get help for mental health concerns were more likely to die from overdose. Peer support specialists can have a positive impact on recovery, care for the infant, and limiting overdose deaths. Yet there is very little research on using peer support. It is critical to have more research on recovery for pregnant women who use opioids. Significant categories could include: mental health, early treatment, peer support.