Interventions for opioid use disorder during the first year postpartum: A systematic review

To provide a qualitative summary of published interventions for postpartum opioid abstinence and reduction in non-prescribed opioid use in patients with opioid use disorder (OUD).

PubMed, CINAHL, PsychINFO, and EMBASE were searched from inception to January 11, 2023. Intervention trials with ≥5 subjects were included if they reported an intervention aimed at opioid abstinence and reduction in non-prescribed opioid use within the first year postpartum in patients with OUD. Studies without a comparison group or intervention not continued into the postpartum period were excluded. Two reviewers independently screened citations and summarized findings from eligible studies using Covidence®. Risk of bias was assessed with Cochrane Risk of Bias or Newcastle-Ottawa Scale as appropriate.

Of the 812 articles screened, 14 were assessed for full-text eligibility and three were included for full-text review. Trials employed a variety of strategies to reduce opioid use including employment for continued abstinence (n = 40), a comprehensive clinical care model (n = 213), and motivational-enhancement therapy (n = 60). Dropout rates were high in two studies, ranging from 22% to 60%, with no dropout noted in the third study. Risk of bias varied between studies.

Despite the large contribution of OUD to maternal mortality, only three intervention studies assessing strategies for postpartum opioid abstinence and reduction in non-prescribed opioid use in patients with OUD were identified. Existing studies were heterogenous and showed limited success in postpartum opioid abstinence and reduction in non-prescribed opioid use among patients with OUD. This underscores the pressing need to address this significant public health concern and contributor to maternal mortality.