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Meta-Analysis
. 2015 Apr 2;2015(4):CD006037.
doi: 10.1002/14651858.CD006037.pub3.

Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

Mishka Terplan  1 , Shaalini Ramanadhan, Abigail Locke, Nyaradzo Longinaker, Steve Lui
Affiliations
Meta-Analysis

Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

Mishka Terplan et al. Cochrane Database Syst Rev. .

Abstract

Background: Illicit drug use in pregnancy is a complex social and public health problem. The consequences of drug use in pregnancy are high for both the woman and her child. Therefore, it is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial interventions in drug treatment but it is unclear whether they are effective in pregnant women. This is an update of a Cochrane review originally published in 2007.

Objectives: To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programmes on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance?

Search methods: We conducted the original literature search in May 2006 and performed the search update up to January 2015. For both review stages (original and update), we searched the Cochrane Drugs and Alcohol Group Trial's register (May 2006 and January 2015); the Cochrane Central Register of Trials (CENTRAL; the Cochrane Library 2015, Issue 1); PubMed (1996 to January 2015); EMBASE (1996 to January 2015); and CINAHL (1982 to January 2015).

Selection criteria: We included randomized controlled trials comparing any psychosocial intervention vs. a control intervention that could include pharmacological treatment, such as methadone maintenance, a different psychosocial intervention, counselling, prenatal care, STD counselling and testing, transportation, or childcare.

Data collection and analysis: We used standard methodological procedures expected by the Cochrane Collaboration. We performed analyses based on three comparisons: any psychosocial intervention vs. control, contingency management (CM) interventions vs. control, and motivational interviewing based (MIB) interventions vs.

Main results: In total, we included 14 studies with 1298 participants: nine studies (704 participants) compared CM vs. control, and five studies (594 participants) compared MIB interventions vs.

Control: We did not find any studies that assessed other types of psychosocial interventions. For the most part, it was unclear if included studies adequately controlled for biases within their studies as such information was not often reported. We assessed risk of bias in the included studies relating to participant selection, allocation concealment, personnel and outcome assessor blinding, and attrition.The included trials rarely captured maternal and neonatal outcomes. For studies that did measure such outcomes, no difference was observed in pre-term birth rates (RR 0.71, 95% confidence interval (CI) 0.34 to 1.51; three trials, 264 participants, moderate quality evidence), maternal toxicity at delivery (RR 1.18, 95% CI 0.52 to 2.65; two trials, 217 participants, moderate quality evidence), or low birth weight (RR 0.72, 95% CI 0.36 to 1.43; one trial, 160 participants, moderate quality evidence). However, the results did show that neonates remained in hospital for fewer days after delivery in CM intervention groups (RR -1.27, 95% CI -2.52 to -0.03; two trials, 103 participants, moderate quality evidence). There were no differences observed at the end of studies in retention or abstinence (as assessed by positive drug test at the end of treatment) in any psychosocial intervention group compared to control (Retention: RR 0.99, 95% CI 0.93 to 1.06, nine trials, 743 participants, low quality evidence; and Abstinence: RR 1.14, 95% CI 0.75 to 1.73, three trials, 367 participants, low quality evidence). These results held for both CM and MIB combined. Overall, the quality of the evidence was low to moderate.

Authors' conclusions: The present evidence suggests that there is no difference in treatment outcomes to address drug use in pregnant women with use of psychosocial interventions, when taken in the presence of other comprehensive care options. However, few studies evaluated obstetrical or neonatal outcomes and rarely did so in a systematic way, making it difficult to assess the effect of psychosocial interventions on these clinically important outcomes. It is important to develop a better evidence base to evaluate psychosocial modalities of treatment in this important population.

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Conflict of interest statement

Mishka Terplan declares no known conflicts of interest. Shaalini Ramanadhan declares no known conflicts of interest. Abigail Locke declares no known conflicts of interest. Nyaradzo Longinaker declares no known conflicts of interest. Steve Lui declares no known conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Neonatal outcomes any psychosocial intervention vs. control, outcome: 1.5 Mean days hospitalized after delivery.
5
5
Forest plot of comparison: 2 CM vs. control, outcome: 3.1 Retention in treatment at the end of study.
1.1
1.1. Analysis
Comparison 1 Any psychosocial intervention vs. control: neonatal outcomes, Outcome 1 Preterm birth (< 37 weeks gestation).
1.2
1.2. Analysis
Comparison 1 Any psychosocial intervention vs. control: neonatal outcomes, Outcome 2 Positive neonatal toxicology at delivery (any drug).
1.3
1.3. Analysis
Comparison 1 Any psychosocial intervention vs. control: neonatal outcomes, Outcome 3 Low birth weight (< 2500 g).
1.4
1.4. Analysis
Comparison 1 Any psychosocial intervention vs. control: neonatal outcomes, Outcome 4 Days hospitalized after delivery.
2.1
2.1. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 1 Positive urine drug test (end of treatment).
2.2
2.2. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 2 Positive urine at 1 month+.
2.3
2.3. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 3 Positive urine at delivery.
2.4
2.4. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 4 Retention at treatment completion.
2.5
2.5. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 5 Short term treatment retention.
2.6
2.6. Analysis
Comparison 2 Any psychosocial intervention vs. control: maternal outcomes, Outcome 6 Retention in treatment at delivery.
3.1
3.1. Analysis
Comparison 3 CM vs. control: maternal outcomes, Outcome 1 Positive urine drug test (end of treatment).
3.2
3.2. Analysis
Comparison 3 CM vs. control: maternal outcomes, Outcome 2 Positive urine at delivery.
3.3
3.3. Analysis
Comparison 3 CM vs. control: maternal outcomes, Outcome 3 Retention at treatment completion.
3.4
3.4. Analysis
Comparison 3 CM vs. control: maternal outcomes, Outcome 4 Short term treatment retention.
3.5
3.5. Analysis
Comparison 3 CM vs. control: maternal outcomes, Outcome 5 Retention at delivery.
4.1
4.1. Analysis
Comparison 4 MIB vs. control: maternal outcomes, Outcome 1 Positive urine drug test (end of treatment).
4.2
4.2. Analysis
Comparison 4 MIB vs. control: maternal outcomes, Outcome 2 Positive urine drug test at three months (follow‐up).
4.3
4.3. Analysis
Comparison 4 MIB vs. control: maternal outcomes, Outcome 3 Positive urine at delivery.
4.4
4.4. Analysis
Comparison 4 MIB vs. control: maternal outcomes, Outcome 4 Retention at treatment completion.
4.5
4.5. Analysis
Comparison 4 MIB vs. control: maternal outcomes, Outcome 5 Short term treatment retention.
See this image and copyright information in PMC

Update of

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