Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Baltimore City Health Department, Baltimore, MD, USA.
Addict Sci Clin Pract. 2024 Oct 15;19(1):73. doi: 10.1186/s13722-024-00507-0.
Overdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.
We conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care.
61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs.
This project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.
药物过量是导致产妇死亡的主要原因；为此，产妇死亡审查委员会建议扩大物质使用障碍（SUD）筛查范围，加强产科和 SUD 治疗提供者之间的合作，并减少护理系统中的碎片化。我们对马里兰州巴尔的摩的围产期 SUD 治疗情况进行了分析，以确定在妊娠和产后期间治疗参与的障碍，并指导系统改进工作。
我们于 2023 年 4 月至 6 月期间对巴尔的摩的 7 家分娩医院、31 家产前护理机构和 108 家 SUD 治疗提供者进行了调查。要求各组织量化对患有阿片类药物使用障碍（OUD）的围产期患者的护理情况，以及筛查、服务可用性、转介实践和改善护理所需的支持情况。
145 家被联系的组织中有 61%做出了回应。分娩医院报告称，与产前护理机构或 SUD 治疗项目相比，他们更频繁地照顾患有 OUD 的孕妇。大多数分娩医院和产前护理机构在入组时报告了对 OUD 的筛查，但少数机构报告使用了经过验证的工具。服务可用性因组织类型和服务类型而异。一般来说，产前护理机构提供的 SUD 相关服务最少。大多数向一般人群提供丁丙诺啡或美沙酮的 SUD 治疗项目也向孕妇提供这些药物。怀孕期间合并酒精/苯二氮䓬类药物使用障碍的戒断管理则更为有限。大多数分娩医院和产前护理机构都既不提供直接纳洛酮分发，也不提供处方。很少有 SUD 治疗项目为围产期患者或幼儿的父母提供量身定制的服务，许多项目不允许儿童在现场。受访者报告称，他们非常有兴趣在产科环境中接受关于妊娠期间 SUD 治疗的教育和咨询支持，以及在 SUD 项目中接受与妊娠相关的医疗问题的教育和咨询支持。
本项目全面介绍了美国主要城市治疗围产期 OUD 的可用服务。研究结果为我们的项目团队正在进行的全市范围的系统改进工作提供了指导，并为其他希望加强围产期 OUD 服务和降低产妇死亡率的司法管辖区提供了模式。
