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Area of Science:

  • Obstetrics and Gynecology
  • Addiction Medicine
  • Public Health

Background:

  • Opioid use disorder (OUD) during pregnancy significantly increases peripartum morbidity and mortality.
  • Overdose deaths among pregnant individuals with OUD are rising.
  • Factors contributing to overdose events require further clarification.

Purpose of the Study:

  • To identify factors associated with lifetime opioid-involved overdose events in pregnant individuals undergoing buprenorphine (BUP) treatment for OUD.
  • To understand the relative contributions of various risk factors to overdose history.

Main Methods:

  • Pregnant individuals (6-30 weeks gestation) receiving BUP for OUD were enrolled in a multisite randomized controlled trial.
  • Baseline data on demographics, substance use, and mental health were collected.
  • Random forest modeling was employed to identify key factors linked to overdose events.

Main Results:

  • The study included 140 pregnant participants, with 55% reporting a history of opioid overdose.
  • Key factors associated with overdose were lifetime heroin use, trauma exposure, financial dependence, depressive symptoms, and lifetime cocaine use.
  • Random forest analysis achieved an area under the curve of 0.797.

Conclusions:

  • Findings highlight the need to address substance use, mental health, and socioeconomic challenges in pregnant individuals with OUD.
  • Targeting modifiable overdose risk factors is crucial for developing effective interventions.
  • Improved outcomes for this population can be achieved through tailored support.