Prevention, Intervention and Evaluation of Maternal Child Health Programs and Practices

PowerPoint presentation given by Diane Abatemarco, PhD, MSW

Treatments for opioid use disorder among pregnant and reproductive-aged women.

The increased prevalence of opioid use disorder and access to medical insurance is subsequently increasing the likelihood that medical professionals will encounter individuals with opioid use disorder. Sharp increases in opioid use disorder among women mean that obstetricians, gynecologists, and other reproductive medicine providers may be especially likely to encounter such patients. Medical professionals\u27 understanding of treatment for opioid use disorder and their roles in their patients\u27 treatment may increase referrals to treatment, reduce stigma, and improve the quality of medical care. Treatment for opioid use disorder falls into four overlapping domains: medication management, medical care, behavioral/mental health care, and psychosocial support. In this review, we discuss these domains with an emphasis on pregnant women and women of reproductive age. Treatment for opioid use disorder is most effective when all providers coordinate care in an informed, nonjudgmental, patient-centered approach

Maternal Stress and Breastfeeding Intention in Pregnant Women with Opioid Use Disorder

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD. Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived Stress Scale-10 (PSS). Characteristics and PSS scores were compared between women who intended to breastfeed and women who did not. ­­­­ Results: The majority of the participants were white (63.2%), smoked (73.7%), in committed relationships (56.1%), and with at least one other child (70.2%). Total PSS scores were not significantly different between women with intention to breastfeed and women without (19.9 vs. 19.6, P=0.874). Breastfeeding intention was higher in women who had a history of breastfeeding (94.5% vs 61.9%, P=0.021). Women who smoked were less likely to report breastfeeding intention than women who did not smoke, though results were not statistically significant (74.4% vs 80%, P=0.739). Conclusion: Future studies with larger sample sizes would be useful to further evaluate the association between breastfeeding history and breastfeeding intention. If an association is found, future interventions promoting breastfeeding in women undergoing treatment for OUD could focus on women who have not previously breastfed

Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder.

Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results: Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions: The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population

Health Status and Preventive Health Services Among Reproductive-Aged Women in Treatment for Opioid Use Disorder

OBJECTIVE: To assess the utilization of preventive health services and the prevalence of chronic health conditions among a cohort of women in treatment for opioid use disorder (OUD). METHODS: Ninety-seven women who were receiving treatment for OUD from a single urban treatment program completed a self-administered anonymous online questionnaire that asked about demographics, health, receipt of preventive health services, and utilization of health care. Descriptive statistics were used to describe data. RESULTS: More than one-third of respondents reported that their health was fair or poor, whereas one-quarter were very concerned with their health. Most participants (59%) reported at least one chronic health condition; nearly 1 in 5 reported two or more conditions. Less than half of respondents had received a routine medical examination in the past year. Vaccine uptake was low; 56% received the coronavirus disease 2019 vaccine and 36% received the annual influenza vaccine. CONCLUSIONS: Women in treatment for OUD could benefit from enhanced health care to address the high rates of chronic diseases and risk factors and underutilization of recommended preventive health services. Interventions and models of care that aim to enhance utilization of such services, and ultimately improve the health of this vulnerable population, may be worth exploring

The Child Healthcare at MATER Pediatric Study (CHAMPS): A 2-Arm Cluster Randomized Control Trial of Group Well Child Care For Mothers in Treatment for Opioid Use Disorder and Their Children

BACKGROUND: Studies suggest that group-based well child care-a shared medical appointment where families come together as a group to receive pediatric primary care-increases patient-reported satisfaction and adherence to recommended care. Evidence supporting the use of group well child care for mothers with opioid use disorder, however, is lacking. The overall objective of the Child Healthcare at MATER Pediatric Study (CHAMPS) trial is to evaluate a group model of well child care for mothers with opioid use disorder and their children. METHODS: CHAMPS is a single-site 2-arm cluster randomized controlled trial. A total of 108 mother-child dyads will be enrolled into the study. Twenty-six clusters of approximately 4 mother-infant dyads each will be randomized 1:1 to one of two study arms (intervention or control). Clustering will be based on child\u27s month of birth. In the intervention arm, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control arm will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study arms will be followed prospectively for 18 months, and data will be compared between the two study arms. Primary outcomes include well child care quality and utilization, child health knowledge, and parenting quality. DISCUSSION: The CHAMPS trial will provide evidence to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care for families impacted by maternal opioid use disorder. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05488379. Registered on Aug. 04, 2022

Understanding Social Needs of Families with Young Overweight Children in an Urban Primary Care Setting: A Mixed-Methods Study

Unmet social needs, such as stable housing, reliable access to food and treatment of parental depression are associated with childhood overweight. Little information exists on parental perception of addressing these needs. We sought to understand the perspective of parents of young overweight children on how to best address social needs in the primary care setting. We conducted a mixed-methods study. The 11-item WE CARE survey, PHQ-2, and 2-item food insecurity screener were used to screen for social needs. Semi-structured interviews were conducted with English-speaking parents of overweight (BMI ≥ 85%) children 2-5 years of age with Medicaid. Interviews assessed parental perception about addressing social needs in the primary care setting. Twenty-two parents participated. Parents responded positively to having a social need 46 times on the WE CARE survey, with the majority being in the areas of smoking cessation and employment. However, parents reported that they did not want to address the majority of these needs at the visit. Only 2 of 11 parents who screened positive for depression on the PHQ-2 endorsed wanting help to address mood, and only 1 in 10 who screened positive for food insecurity endorsed wanting help accessing food. Two salient themes arose during the interviews that influence asking for support: 1) level of comfort disclosing needs and 2) family resourcefulness and resiliency. Discomfort was associated with parental fear of being considered neglectful and involvement of child protective services. Though a majority of parents found the screener to be useful, they suggested reframing to highlight support available, emphasizing how resources may benefit the child. Screening tools may benefit from adaptation for families are uncomfortable asking for support or who are resourceful at meeting their needs. Emphasizing the non-punitive nature and providing information on resources upfront may promote resource utilization among this patient population

Diane J. Abatemarco\u27s Story

Diane J. Abatemarco, PhD, MSW, Professor, Associate Dean, Jefferson College of Nursing; Executive and Founding Director of Maternal Addiction Treatment, Education and Research (MATER) Cente

Delay discounting of pregnancy- and condom-protected sex among methadone-maintained women

Introduction Over 80% of pregnancies are unintended among women with opioid use disorder (OUD; Heil et al., 2011). Use of effective contraception is uncommon in this population (Terplan et al., 2015). Initiating and using effective contraception involves delays: to obtain the method from a provider, to become protected after initiating use. Interventions that include delay reductions among other elements have increased contraceptive use (Heil et al., 2016; Secura et al., 2014). Women with OUD have reported greater likelihood of engaging in unprotected sex at shorter delays to acquiring protection from sexually-transmitted infection (STI) than women without OUD (Herrmann et al., 2014). There is no current method for assessing how delays to pregnancy protection affect sexual decision-making. The present study was designed to evaluate a novel tool for measuring how delays to pregnancy protection affect self-reported likelihood to engage in protected vs. unprotected sexual intercourse