The COVID-19 pandemic in the United States was likely to have had a severe and disproportionate impact on persons with substance use disorders (SUDs), including pregnant and postpartum women with opioid use disorder (OUD). Pregnant women with OUD were at greater risk for COVID-19-related complications because they had a greater risk of complications from respiratory infections, such as influenza and SARS-CoV, and had higher rates of tobacco (54% vs 12%) and marijuana (12% vs 2%) use compared to non-OUD pregnant women.
Further, analyses from the current R01 had demonstrated that OUD during pregnancy was independently associated with a 50% increase in the risk of severe maternal morbidity (SMM). COVID-19 infection had further exacerbated high rates of adverse maternal (i.e., overdose, SMM) and perinatal (i.e., preterm birth, low birthweight) health outcomes among pregnant women with OUD.
Medications for OUD (MOUD) markedly reduced the risk of relapse and overdose mortality and were associated with significant reductions in the risk of preterm birth and low birthweight among pregnant women with OUD. Despite this, analyses from the current R01 had shown that 44% of pregnant women with OUD did not use MOUD, less than half utilized any behavioral health services, and 3% experienced an overdose event during pregnancy or the postpartum period.
Modifications to the substance use treatment process due to COVID-19, such as changes in the type (telemedicine vs. in-person), frequency (monthly vs. biweekly), and quality (lack of urine drug screening) of treatment services, had created additional barriers to MOUD use during pregnancy. Thus, there had been a critical need to understand how COVID-19 infection influenced health outcomes among pregnant women with OUD and how the broad impacts of COVID-19 (i.e., healthcare system changes) affected access to and quality of substance use treatment for pregnant and postpartum women with OUD.
The project aimed to:
- Evaluate how COVID-19 infection influenced the rate of adverse maternal and perinatal health outcomes among pregnant and postpartum women with OUD, and
- Understand how the broad impacts of COVID-19 (i.e., healthcare system changes) affected access to and quality of addiction treatment for pregnant and postpartum women with OUD.
