Substance Use Treatment Retention after Redesign of a Comprehensive Addiction and Pregnancy Program in Baltimore,...

Substance use disorder (SUD) is a significant cause of morbidity and mortality among perinatal people. Integrated perinatal SUD treatment programs (SUD, obstetrics, mental health, and other services) show promising improvements in SUD and perinatal outcomes. This study describes the redesign of an integrated perinatal SUD treatment program that partnered with a community-based recovery housing facility to integrate clinical and social services and evaluated the impact of this redesign on several indices of treatment retention.

This retrospective cohort study used health record data from 164 perinatal people aged 18+ years admitted to an integrated intensive outpatient SUD treatment program in Baltimore, Maryland, between March 8, 2021, and June 11, 2025. Negative binomial regression was used to examine the association between the program redesign and length of treatment, and logistic regression was used to examine associations between program redesign and retention (until delivery and at 30-, 60-, and 90-days postpartum).

Perinatal people admitted post-redesign had a 108% increase in length of treatment compared to people admitted pre-redesign (adjusted incidence rate ratios [aIRR] 2.08, 95% CI: 1.40, 3.10). People admitted post-redesign had greater odds of treatment retention until delivery (aOR 3.53, 95% CI: 1.39, 8.95); and greater odds of treatment retention at 30-, 60-, and 90-day postpartum compared to people admitted pre-redesign (adjusted odds ratio [aOR] 6.58, 95% CI: 2.52, 17.16; aOR 9.87, 95% CI: 3.47, 28.07; and aOR 5.50, 95% CI: 1.98, 15.27, respectively).

The study illustrates the benefits of creating community partnerships to deliver integrated clinical and social services to perinatal people with severe forms of SUD.