Advancing preventive interventions for pregnant women who are opioid using via the integration of addiction and mental health research

Abstract

Purpose of review: This review examines how research focused on treatment for opioid use in perinatal populations and preventive interventions for postpartum psychopathology have remained separate, despite significant overlap.

Recent findings: Guidelines for best practice in caring for pregnant women with opioid use disorder suggest the use of medication-assisted treatment with additional comprehensive care, including behavioral and mental health interventions. However, intervention research often mutually excludes these two populations, with studies of behavioral interventions for opioid use excluding women with psychopathology and research on preventive interventions for postpartum psychopathology excluding women who are substance using.

Summary: There is a limited evidence-base to inform the selection of appropriate preventive interventions for pregnant women with opioid use disorder that can address opioid use and/or treatment adherence and concurrent mental health risks. We argue it is critical to integrate research on pregnant women who are opioid using and preventive perinatal mental health interventions to catalyze pivotal change in how we address the opioid epidemic within this growing population.

Keywords: opioid use; opioid use disorder; perinatal mental health; postpartum mental health; pregnancy.

Figure 1.

Prevailing separate lines of research into opioid use and other psychiatric conditions during pregnancy versus an integrated approach. Prevailing approaches contribute to parallel lines of research into opioid use disorder (OUD) versus other psychiatric conditions and risk factors during pregnancy, missing the critical intersection. An integrated approach to both basic and intervention research has potential to advance understanding of the overlap and reciprocal connections between OUD, existing psychiatric conditions, and risk factors for postpartum psychiatric conditions (e.g. history of depression and trauma). Such an approach also draws attention to important questions regarding how treatments for psychiatric conditions during pregnancy (psychotherapy and psychotropic medications) may work for women with OUD, and/or interact with treatments targeting OUD (e.g. medication assisted treatment [MAT]). Finally, the integrated approach lends towards conceptualizing outcomes at multiple levels and considering associations between them.