MOTHER-INFANT DYAD PROJECT
The Ohio Perinatal Quality Collaborative aims to optimize post-partum support (through 12 months of life) for the mother with Opioid Use Disorder (OUD) and her baby by June 30, 2023 by working with a group of healthcare sites that provide care for both women and children.
We want to assure mom is supported during her recovery journey while maintaining sobriety, build mom’s capacity to parent her infant, and ensure the health and safety of the baby during the first year of life. Adapting a framework from a recent summary publication (1), the maternal/infant dyad project will work to support care teams in meeting the following key objectives:
Providing prioritized, seamless, and integrated care coordination
Removing barriers to integrated medical and behavioral services
Ensuring child safety and health while maintaining parental trust
Nationally, as well as in Ohio, substance use is escalating along with the prevalence of opioid use disorder (OUD) in pregnant and postpartum women and newborns with prenatal substance exposure (2). While pregnancy is often a time of motivation for sobriety, relapse rates in the first year postpartum continue to increase (3). Maternal mortality reviews in several states have identified substance use as a major risk factor for pregnancy-associated deaths (4). The Ohio Pregnancy-Associated Mortality Review (PAMR) reported that from the years 2008-2016, unintentional drug overdose was the leading cause of pregnancy-associated deaths in the state (see figure 8, 5). Data from these various sources suggest that continuation in Medication Assisted Treatment (MAT) and retention in care is crucial to reduce the risk of relapse and overdose or death for the postpartum mother (6, 7).
Prenatal substance use impacts both the mom and the baby, therefore ideal care is to support the dyad postpartum, caring for the mom and the baby. Substance exposed infants have increased risk (50% less likely) of not receiving recommended well child care (WCC) and moms who used illicit substances during pregnancy are less likely to receive postpartum care (40%) than those without a diagnosis of substance use disorder. Moms with OUD have shared how challenging it is to maintain their recovery with so many barriers and stigma towards them. Many have stated that success to them would be maintaining their sobriety and being able to parent their baby (8).
True dyad care addresses physical health (primary care and health care maintenance for both mom and baby), mental health (maternal MAT and BH treatment) and social supports. Learning from care sites and developing a roadmap for dyad care has the potential to improve maternal rates of retention in care and health care outcomes for mom and baby.
PROVIDER RESOURCES
From MOMS+:
Pause Before You Prescribe Opioids (brochure for clinicians who prescribe to women of reproductive age)
Your Recovery is the Priority (poster for women in treatment)
From NAS:
PATIENT RESOURCES
From MOMS+:
Are You in Treatment or Recovery? (brochure for women in treatment)
References
Though the terms “mother” and “mom” are used throughout this Charter, it is important to recognize that some who experience pregnancy do not identify as women. This initiative is meant to be inclusive of all pregnant persons who experience pregnancy, regardless of gender identity.
Schiff DM, Partridge S, Gummadi NH, Gray JR, Stulac S, Costello E, Wachman EM, Jones HE, Greenfield SF, Taveras EM, Bernstein JA. Caring for Families Impacted by Opioid Use: A Qualitative Analysis of Integrated Program Designs. Acad Pediatr. 2021 Apr 24:S1876-2859(21)00236-9. doi: 10.1016/j.acap.2021.04.016. Epub ahead of print. PMID: 33901729; PMCID: PMC8542059.
Crane, D., Marcotte, M., Applegate, M., Massatti, R., Hurst, M., Menegay, M., ... & Williams, S. (2019). A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants. Journal of substance abuse treatment, 102, 53-59.
Wilder, C., Lewis, D., & Winhusen, T. (2015). Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder. Drug and alcohol dependence, 149, 225-231.
Smid, M. C., Schauberger, C. W., Terplan, M., & Wright, T. E. (2020). Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction. American Journal of Obstetrics & Gynecology MFM, 2(4).
Ohio Department of Health. (2020). Special Topics Report on Pregnancy-Associated Deaths Due to Unintentional Overdose in Ohio, 2008-2016. Columbus, OH: Ohio Department of Health.
Kroelinger, C. D., Rice, M. E., Cox, S., Hickner, H. R., Weber, M. K., Romero, L., ... & Barfield, W. D. (2019). State strategies to address opioid use disorder among pregnant and postpartum women and infants prenatally exposed to substances, including infants with neonatal abstinence syndrome. Morbidity and Mortality Weekly Report, 68(36), 777.
Substance Abuse and Mental Health Services Administration. (2016). A collaborative approach to the treatment of pregnant women with opioid use disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration,, 1-124.
Patient-Centered Outcomes Research Institute. (2021). Empowering mothers and providers and other stakeholders to weigh in as experts in research (EMPOWER). https://www.pcori.org/research-results/2020/empowering-mothers-and-providers-and-other-stakeholders-weigh-experts-research.
The OPQC Mother-Infant Dyad Project is funded by the Ohio Department of Medicaid (ODM). The views expressed on this website are solely those of the authors and do not represent the views of state or federal Medicaid programs.