Telehealth-Based OUD Treatment May Lead to Better Health, Obstetric Outcomes Among Pregnant Patients

Telehealth-based opioid use disorder (OUD) treatment among pregnant patients may lead to better health and obstetrics outcomes, according to new findings published in JAMA Network Open.¹

Opioids have emerged as a primary treatment for pain management during pregnancy, with some research suggesting that up to 21% of pregnant patients use the drugs at some point in their gestation period.² But, while opioids can be helpful in managing pregnancy-related pain, their use has been linked to poor health outcomes. These risks, such as higher chances of preterm birth, are even greater for pregnant women who develop OUD.

Although OUD has contributed to high rates of maternal morbidity and mortality in the US, use of buprenorphine, an FDA-approved medication to treat OUD, has been proven to be safe and effective during pregnancy. However, barriers like stigma, fear, and legal consequences have made accessing treatment a challenge.³

By offering remote access, telehealth can make OUD treatment more discreet and convenient. This approach can reach patients in underserved rural areas, improve treatment efficiency without increasing costs, and significantly reduce travel time and wait times for patients.⁴

In conducting their study, investigators sought to supplement the body of evidence regarding treatment success and obstetric outcomes among pregnant patients receiving care through a dedicated telehealth OUD care program.

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Investigators recruited 94 individuals who were aged 18 years or older, were diagnosed with OUD, received buprenorphine or buprenorphine and naloxone treatment, and had documentation of self-reported pregnancy in problem lists between January 1, 2018, and December 31, 2022. These individuals received OUD care through a low-barrier, multistate telemedicine addiction treatment program in the US.

Among the study cohort, 40 patients (42.6%) were pregnant during their initial telehealth OUD appointment and 54 (57.4%) became pregnant after establishing care.

The primary outcome was continuous OUD care through pregnancy vs discharge due to loss to follow-up or administrative or financial reasons.

Seventy-five (79.8%) patients received continuous OUD care, but 6 (6.4%) patients transferred care to prenatal clinicians. Of the remaining 69 patients who continued with telehealth, 65 (94.2%) received care through 6-weeks post pregnancy, and all patients tested positive for buprenorphine in post pregnancy urine drug screens. In this subgroup, 52 (82.6%) patients carried to term, 9 (13.0%) patients experienced spontaneous terminations, and 3 (4.3%) experienced medical terminations.

Nineteen patients (20.2%) did not receive continuous OUD care. This subgroup included 13 (13.8%) patients who were lost to follow-up and 6 (6.4%) patients who were discharged due to administrative or financial reasons.

Patients who became pregnant once established in care were more likely to receive continuous care compared with those who were pregnant at treatment initiation.

To the investigators’ knowledge, the current study is the first to elicit data regarding treatment success and obstetric outcomes among pregnant people receiving care through a dedicated telehealth OUD care program. Although they noted study limitations, including a small sample size making it so that findings may not be generalizable to other settings, investigators concluded that their findings add to the emerging evidence supporting the effectiveness of telehealth-based OUD treatment among pregnant patients.

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References

1. Coffey MJ, Weng M, Jimes C, Brigham S, Lira MC. Telehealth treatment for opioid use disorder during pregnancy. JAMA Netw Open. 2024;7(3):e242463. doi:10.1001/jamanetworkopen.2024.2463

2. Meara K. Opioid exposure during pregnancy linked with increased risk of preterm birth. News article. Drug Topics. February 15, 2024. Accessed March 15, 2024. https://www.drugtopics.com/view/opioid-exposure-during-pregnancy-linked-with-increased-risk-of-preterm-birth

3. Saia KA, Schiff D, Wachman EM, et al. Caring for pregnant women with opioid use disorder in the USA: Expanding and improving treatment. Curr Obstet Gynecol Rep. 2016;5(3):257-263. doi:10.1007/s13669-016-0168-9

4. Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. J Nurse Pract. 2021;17(2):218-221. doi:10.1016/j.nurpra.2020.09.013