Statewide initiative improves opioid use disorder care for pregnant patients

Statewide initiative improves opioid use disorder care for pregnant patients | Image Credit: © BillionPhotos.com - © BillionPhotos.com - stock.adobe.com.

Opioid use disorder (OUD) care among pregnant patient is improved through the Mothers and Newborns affected by Opioids - Obstetric (MNO-OB) initiative, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

An increase in maternal death linked to OUD has been reported in US women. Drug overdose was linked to 22% of pregnancy-associated deaths between 2016 and 2017, with 98% of these deaths being deemed preventable.²

Medication-assisted treatment (MAT) and recovery treatment services may be used to treat OUD.¹ Guidelines for comprehensive obstetrical care include universal screening for substance use disorder (SUD) with a validated tool.

According to investigators, “universal screening of substance use and SUD among birthing people is not widely practiced.” Therefore, a study was conducted to assess the efficacy of the MNO-OB initiative toward improving OUD care.

Participating hospitals worked to adapt facility-wide validated screening protocols, help patients with OUD receive MAT and recovery treatment services, provide naloxone counseling, and provide OUD education to patients and providers.

Quality improvement resources used by participating teams included checklists, protocols, provider education resources, order sets, and patient-centered education materials. Data on delivering patients with OUD was obtained through medical record audits on the monthly MNO-OB patient data form.

Baseline data from before the initiative launch was compared to prospective data leading to the initiative’s end. These periods were from October 2017 to December 2017 and from July 2018 to December 2020, respectively. OUD was determined using International Classification of Diseases, Tenth Revision, codes.

Participants included pregnant women with OUD based on a positive self-report screen, a positive opioid toxicology test during pregnancy, the use of nonprescribed opioids during pregnancy, or the use of prescribed opioids for longer than a month in the third trimester.

Patient-level measures included OUD screening, connection to MAT, linkage to recovery treatment services, and provision of naloxone counseling. Hospital-level measures included low or moderate-to-high birth volume, rural vs urban status, geographic location, birth volume, race and ethnicity of patients, perinatal level, and insurance status.

There were 2095 pregnant patients with OUD across 91 hospitals included in the analysis, aged a mean 30.1±5.32 years. Of OUD patients, 72% were White, 19.5% Black, 3.2% Hispanic, and 5.4% other race or ethnicity. Prenatal care before delivery was reported in 78.7%.

Urban status was reported for 86.5% of hospitals and rural for 8.5%. Additionally, 24.2% were perinatal level 1 or 2, 11.2% level 2+, and 59.2% level 3.

Following implementation of the MNO-OB initiative, prenatal screening rates with a validated self-report screening tool rose from 2% to 42%. Rates of screening at the delivery admission rose from 2% to 88%.

MAT linkage before discharge become more common, from 41% before the initiative to 78% after. Rates of linkage to recovery services were 48% and 68%, respectively, and rates of naloxone counseling were 2% and 44%, respectively. This indicated an increase in odds of 13% per quarter for linkage to recovery services and 49% for naloxone counseling.

Black patients experienced a 17% increase in the odds of receiving MAT each quarter, vs 9% for White patients. All racial and ethnic subgroups reported increased MAT rates, but the most significant increase was in Black patients, reducing the disparity gap.

These results indicated increases in optimal OUD care among OUD patients following implementation of the MNO-OB initiative. Investigators concluded statewide initiatives “to address optimal OUD care can enhance the outcomes of pregnant patients and help to close racial disparities in the receipt of optimal care.”

References

1. Lee Kin PA, Lee SY, Weiss D, et al. Implementation of perinatal quality collaborative statewide initiative improves obstetrical opioid use disorder care and outcomes. Am J Obstet Gynecol. 2025;232:130.e1-10. doi:10.1016/j.ajog.2024.04.015
2. Illinois maternal morbidity and mortality report 2016–2017. Illinois Department of Public Health. Accessed January 28, 2024. https://dph.illinois.gov/content/dam/soi/en/web/idph/files/maternalmorbiditymortalityreport0421.pdf