MOms in REcovery (MORE) Study: Defining Optimal Care

Northern New England has among the highest rates of opioid dependence in the U.S. This region also has among the highest rates of opioid-related deaths in the U.S., with a disproportionate high rate among pregnant women with opioid use disorder. Newborns impacted by OUD have increased risk of poor outcomes, including preterm birth and long hospitalization for neonatal withdrawal and other newborn complications. For pregnant women with OUD, medication treatment (MOUD) significantly reduces these risks. Many maternity care providers have begun to prescribe MOUD in their practices. Other practices have maintained the longstanding evidence-based standard of care, referral of patients with OUD to specialty treatment programs. Most pregnant women with OUD have other psychosocial needs, ranging from lack of housing and untreated mental health conditions, to need for parenting education and support. There is variability among practices in terms of types of other services provided to patients. Although pregnancy is a time when women are highly motivated to start MOUD, many women are also likely to discontinue MOUD postpartum due to loss of insurance coverage, difficulty transitioning to another provider, loss of motivation for treatment, or competing demands on time and resources as a new parent. The challenge for patients, providers, and other stakeholders is to understand the relative advantage of the two MOUD models (receiving MOUD as part of maternity care or at a specialty program) for improving key outcomes for baby \& mother. A second challenge is to understand the relative contributions of onsite services such as mental health care, care coordination and parenting education to improved outcomes. Addressing these challenges is particularly important in rural areas where obstetric practices \& specialty care services are limited. Patients, providers \& other stakeholders need guidance in choosing the optimal models for building programs to provide maternity care for women with OUD.

Inclusion Criteria: * Age 16 year and older, * Identified opioid use disorder, * Receiving prenatal care for current pregnancy at partner practice, * Clinic-recorded diagnosis of opioid use disorder, * Willing and able to provide informed consent. Exclusion Criteria: * Ward of the State