Engagement with pregnancy outreach services among substance-involved pregnant people: a retrospective chart review

Abstract Background Substance use in pregnancy is a significant public health issue and is associated with adverse maternal and infant outcomes, yet engagement in community-based pregnancy outreach programs remains poorly understood. We aimed to characterize individuals referred to a pregnancy outreach program, describe service use, and identify characteristics that are associated with engagement, service duration, and postnatal service use. Methods We conducted a retrospective chart review of 633 pregnant people referred to a pregnancy outreach program in Toronto, Canada between 2000 and 2025. Multivariable regression models were used to estimate and identify characteristics associated with the following outcomes: odds of engaging in services during pregnancy, months of service duration, and number of direct and indirect service contacts. Results Participants were on average 28.3 years old and 20 weeks’ gestation at referral, with 74.8% receiving social assistance and 48.0% being unhoused. Overall, 60.2% engaged in pregnancy outreach services. Among those engaged, median service duration was 4.0 months and 35.4% transitioned to postnatal services. Engagement was more likely among individuals who were precariously housed versus unhoused (OR: 3.301, 95% CI: 2.008, 5.428), those engaging in polysubstance use versus using one substance (OR: 4.295, CI: 2.708, 6.811), and less likely among those with versus without child welfare involvement (OR: 0.221, 95% CI: 0.113, 0.433). Receiving social assistance versus not receiving social assistance was consistently associated with service duration and number of service contacts. Conclusion The pregnancy outreach program engages a substantial proportion of substance-involved pregnant people referred to their services, with those experiencing more stability (i.e., being housed and on social assistance) being more likely to access outreach services. Enhancing integration with housing, social assistance, child welfare and postnatal supports may improve equitable access and continuity of care.