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

OBJECTIVE: 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). MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.