A Scoping Review of Maternal Substance Use and Peer Support and Its Implications for Maternal Health Providers

BACKGROUND: The number of pregnant and postpartum women with opioid use disorder (PPWOUD) quadrupled since 1999, signifying a public health crisis. OBJECTIVES: This scoping review examined the strength and consistency of findings in medical and social science literature regarding maternal recovery, capacity, and mortality from overdose, and the influence of recovery peer support specialists (RPSS). INCLUSION CRITERIA: Study designs included clinical trials, cohort studies, case reports, case series, historical controls, and qualitative research and encompassed quantitative, qualitative, and mixed-methods studies. Excluded were studies with medication as the sole treatment for OUD, neonatal outcomes only, mortality specific to self-harm, and studies based outside the United States. Five authors independently evaluated inclusion criteria, extracted data, and assessed quality. SEARCH STRATEGY: PubMed, CINAHL, OneSearch, Clinicaltrials.gov, WHO, Embase, and Cochrane Review were searched from January 2000 to August 2021, with results reviewed between June and August 2021. STUDY SELECTION: Diverse study designs were used (observational cohorts, retrospective and prospective cohorts, cross-sectional studies, randomized trial protocols, and systematic reviews) across quantitative, qualitative, and mixed-methods approaches, organizing them within an eco-systems framework spanning pregnancy through 12 months postpartum to assess maternal recovery, capacity, and opioid-related mortality (Aims 1-3) and to contextualize these outcomes within the broader public health crisis and potential role of RPSS (Aim 4). DATA EXTRACTION: Demographics, covariates, sources of bias, and effect size were compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) statement. Fourteen studies met inclusion criteria with the eco-systems framework. RESULTS: Aim 1, maternal recovery: early medication for OUD and mental health disorders, patient navigator, and RPSS had positive outcomes. Aim 2, maternal capacity: parental support was impactful, with external stigma and separation from their child having a negative impact. Aim 3, maternal mortality from opioid overdose: infant removal and untreated mental health were contributing factors. Aim 4, perceived effectiveness of RPSS: RPSS may support maternal recovery and capacity and reduce mortality from overdose, albeit the paucity of research. CONCLUSIONS: RPSS positioned to support PPWOUD may aid in effectively addressing this public health concern. Incorporating anti-oppressive practices and promoting agency for PPWOUD would increase access to services. Recommendations are to invest in research on recovery, emphasizing mental health, early treatment, and peer support to help coordinate and facilitate mental health services.