Substance Use Disorders during Pregnancy: Comprehensive Care and Predictors of Delivery Outcomes

Abstract

Introduction: Illicit substance use is increasing among pregnant women seeking treatment for substance use disorders. Resources are scarce for this vulnerable population in terms of addressing their complex needs. Comprehensive care programs offering perinatal care services and substance abuse treatment in a single location have been found to favorably treat pregnant clients and positively affect neonatal and maternal delivery outcomes.

Purpose: To review comprehensive care program studies, evaluate research quality, and examine outcome criteria. Also, to examine the impact of pregnant women’s comprehensive care attendance and pre-treatment psychiatric severity on neonatal and maternal delivery outcomes.

Methods: A systematic literature review was conducted on treatment programs offering a so called “one-stop” comprehensive care approach. A secondary analysis study was employed to examine the effects of treatment attendance on neonatal and maternal delivery outcomes for pregnant women with substance use disorders receiving comprehensive care. A subsequent secondary analysis study was completed to determine the relationship between pre-treatment psychiatric severity and delivery outcomes for pregnant clients with substance use disorders in a comprehensive program.

Results: The literature review identified thirteen comprehensive care studies, most of which used an observational design. Overall study quality was assessed as moderate for reporting and strength of evidence. Outcome criteria measures often included neonatal parameters such as weight, estimated gestation age, neonatal abstinence syndrome, and hospital length of stay, and maternal delivery outcomes frequently included urine toxicology screens on delivery and hospital length of stay. The first data analysis indicated comprehensive care attendance was favorably related to most neonatal and maternal delivery outcomes. The second data analysis showed similar neonatal and maternal outcomes regardless of psychiatric severity grouping, suggesting comprehensive care as an effective treatment for those with high levels of psychiatric symptomology.

Conclusion: Results across all three manuscripts illustrate comprehensive care models as a favorable treatment approach for pregnant women with substance use disorders.