Patient-Centered Outcomes Research Institute (PCORI)
8/1/2018 - 6/1/2024
Sarah Lord, PhD (Geisel School of Medicine at Dartmouth College); Daisy Goodman, CNM, DNP, MPH (Geisel School of Medicine at Dartmouth College)
Other Project Staff
Martha Bruce, PhD; Mary Brunette, MD; Haiyi Xie, PhD
Northern New England (Vermont, New Hampshire, Maine) has among the highest rates of opioid dependence and opioid related deaths in the country. The opioid epidemic can also be seen among pregnant mothers in the region. In Northern New England an average 5-8% of newborns are born to mothers with opioid use disorders (OUD), with considerable regional variation in rates. Medication assisted treatment (MAT) for pregnant women can reduce risks to infants, and women with OUD may be particularly motivated to initiate MAT. Regional maternity care practices fall into two broad categories: Integrated models, in which maternity care, MAT, and psychosocial services are provided together, or Referral-Based models, where maternity care is provided at one location and women are referred to community providers for MAT and other services. Within these categories there is considerable variation in the types of supports and level of care coordination provided, as well as in women’s preferences and their ability to interact with available services.
Our goal in this 4-year comparative effectiveness study is to explore the impact of different models of MAT for pregnant women with OUD on maternal and infant outcomes, both during pregnancy and after delivery. Our research questions are based on an urgent need expressed by patients, providers, and policymakers to identify what model of care is best for women and their infants: 1) Which model of care is most beneficial for maternal and neonatal outcomes, including perinatal complications, neonatal opioid withdrawal syndrome, opioid and other substance use, treatment engagement during and after pregnancy, maternal quality of life, and retention of child custody? 2) Does the impact of different MAT models vary based on a women’s mental health or addiction severity? 3) What psychosocial services produce better outcomes for moms and infants?
We will use a mixed methods approach to address research questions, using four sources of data collection. We will abstract de-identified data from perinatal records for women with opioid use disorder to assess maternal, neonatal, and substance use treatment outcomes (n=2000), A recruited sample of women with OUD receiving maternity care at partner practices (n=523) will complete surveys on three occasions (3rd trimester, 3 months and 6 months postpartum). A subsample (n=30) of the recruited sample will be followed and interviewed to obtain a deeper understanding of experiences of care, and benefits and challenges of the different care models over time. Clinicians and staff from partner practices will also complete surveys and interviews regarding their perceptions of optimal perinatal care of women with OUD.
We are partnering with 21 maternity care practices across New Hampshire, Vermont, and Maine, A Study Advisory Committee that includes maternity care and and pediatric providers, addiction treatment clinicians, state Medicaid and policy representatives, community advocates, and pregnant and parenting women with lived experience with opioid use will be integrally involved in all aspects of the study, from planning and recruitment, to data collection, analysis, and presentation of results. This collaborative research approach is what we believe will make this project a success and help to ensure that we can deliver actionable results that can help improve outcomes for pregnant women and their children.
Public Health Relevance
Results from this project will help patients, providers, payers, and policy-makers make care decisions and design programs that best serve pregnant women and their infants.