Abstract
Background:
Substance use during pregnancy is a growing public health concern, yet little is known about how universal screening translates into the identification of a substance use disorder (SUD) and treatment engagement, across the perinatal SUD continuum of care. Persistent disparities in screening, identification, and treatment may contribute to missed opportunities for timely intervention and exacerbate inequities in maternal health. This study examined national patterns of substance use screening, SUD prevalence, and treatment engagement among pregnant women in the United States.
Methods:
Data were drawn from the 2021 to 2023 National Survey on Drug Use and Health. The sample consisted of pregnant females aged 12 to 49 years (N = 2 051; weighted population estimate 2,037,128). Outcomes included healthcare professional-initiated screening for drug and alcohol use, SUD diagnosis, and SUD treatment engagement. Researchers estimated the prevalence of each outcome and conducted survey-weighted logistic regression to assess sociodemographic, clinical, and structural correlates.
Results:
Nearly two-thirds of pregnant women (64.7%) reported being screened for substance use in the past year, 14.3% met criteria for a past-year SUD, and only 10% of those with SUD received treatment. Screening and SUD prevalence varied significantly by age, race/ethnicity, educational attainment, income level, insurance type, mental health status, and criminal justice involvement. Screening alone was not associated with treatment receipt; however, a provider-initiated conversation about treatment options and/or substance use was associated with more than 10-fold higher odds of treatment engagement. Substantial attrition between screening and treatment was observed, with disparities across sociodemographic and geographic groups.
Conclusion:
Most pregnant women receive substance use screening nationwide, but few who meet the criteria for a SUD ultimately receive treatment, indicating critical gaps in the perinatal SUD care continuum. Findings underscore the need to strengthen post-screening follow-up, including provider communication, care coordination, and integrated obstetric-behavioral health models, to ensure that identification leads to timely, patient-centered treatment. Addressing the barriers and inequities in screening, diagnosis, and treatment engagement is essential for advancing maternal health equity and improving outcomes for pregnant women with SUD.
Highlights
A high proportion of pregnant women are screened for substance use, but few receive needed substance use treatment.
Follow-up conversations after screening strongly increase treatment participation.
Screening disparities show unequal access to early identification and care.
Clinicians and policymakers can improve maternal health by integrating care systems and expanding flexible, low-barrier treatment options like telehealth.
Introduction
Substance use during pregnancy is a growing public health concern in the United States. In 2023, an estimated 4.9% of pregnant women in the United States reported using illicit substances and 8.4% reported drinking alcohol within the past month. 1 Such use, regardless of whether it reflects an underlying substance use disorder (SUD), is associated with adverse outcomes across nearly all domains of maternal and fetal health, including preterm birth, 2 fetal anomalies, 2 neonatal abstinence syndrome, 3 and increased maternal morbidity and mortality.4,5 Substance-related deaths during pregnancy have nearly doubled over the past decade, accounting for approximately 11% of all US pregnancy-related deaths between 2010 and 2019. 6
Despite the heightened risks among pregnant women with SUDs, many women report increased motivation to reduce substance use and have more frequent contact with medical professionals.7,8 This creates an opportunity for healthcare providers to identify pregnant women with SUDs and facilitate timely linkages to treatment.9 -12 Nevertheless, pregnant women with SUDs are often unidentified, and only a small fraction (12.8%) receive treatment.13 -16
Improving maternal health outcomes for women with SUDs requires increased efforts to enhance early identification and access to care. 17 To this end, universal screening of pregnant and reproductive-age women is recognized as an effective strategy for early identification of SUDs and is considered a national healthcare priority. The US Preventive Task Force recommends SUD screening via a patient interview for all adults over 18 years old, 18 and the American College of Obstetricians and Gynecologists recommends incorporating substance use screening into the first prenatal visit as part of comprehensive, universal prenatal care. 19 The purpose of screening is to stratify women into risk categories that guide the appropriate level of care. Those at low risk (i.e., no past or current substance use) should receive brief advice and reinforcement of healthy behaviors. Those at moderate risk (i.e., a history of use without meeting SUD criteria) should receive brief motivational interventions and regular follow-up visits. Women who meet diagnostic criteria for an SUD are considered high risk; while they may also benefit from brief motivational interventions, it is recommended that they be referred to specialty SUD treatment.20,21
Universal screening has been identified as a way to provide effective treatment by identifying pregnant women who need alcohol and/or drug treatment earlier in pregnancy and then connecting them to needed services. 17 However, screening rates are often inconsistent, and validated tools specifically designed for use with pregnant women remain underutilized.22,23 In addition, many pregnant women may choose not to disclose substance use due to fear of stigma or potential legal repercussions. 24
Although universal screening is intended to be a first step toward connecting pregnant women to needed services, few studies have evaluated whether being screened leads to increased treatment receipt among women identified as having SUDs. 25 Moreover, significant barriers within the health and social care systems limit access to perinatal SUD treatment. Difficulties with transportation, insufficient insurance coverage, stigma, and financial instability can hinder access to treatment.7,26 Furthermore, evidence suggests that very few facilities offer SUD treatment services that are responsive to the unique needs of this population, such as childcare, housing that allows parent and child dyads to remain together, or prenatal care.27,28 The effects of these barriers may be compounded for women with pre-existing inequities such as lower income levels, lower educational attainment, and Black, Indigenous, and/or people of color, who have been shown to have lower rates of treatment engagement for SUDs.29 -32
Examining inequities in substance use care during pregnancy—from screening through treatment engagement—has important implications for advancing maternal and infant health equity. 17 Understanding how screening practices relate to treatment receipt can inform interventions that expand screening and strengthen diagnosis, triage, and linkage to care. Although prior studies have examined screening rates and treatment utilization separately, few have explored their relationship among pregnant women with SUDs. This gap limits understanding of how disparities compound across the care continuum and where opportunities exist to improve continuity of substance use care during pregnancy.
Accordingly, the purpose of this study was to examine patterns of substance use screening, SUD diagnosis, and treatment engagement among pregnant women in the United States using data from the National Survey on Drug Use and Health (NSDUH). This study is guided by a care cascade framework, 33 in which screening, diagnosis, and treatment engagement are understood as successive but interdependent stages of care. Gaps at any point along this care continuum carry the risk of increasing attrition rates in subsequent stages and exacerbating disparities in outcomes. Our primary aim was to estimate the prevalence and describe the characteristics of pregnant women who, within the past 12 months, were screened for substance use by a healthcare provider, met diagnostic criteria for an SUD, and received SUD treatment.
Methods
Data Source and Participants
Data were drawn from the 2021 to 2023 NSDUH, an annual, nationally representative cross-sectional survey of non-institutionalized individuals aged 12 years and older in the United States. 34 The NSDUH employs a multistage area probability sampling design, with sampling weights applied to account for nonresponse and intentional oversampling of specific demographic groups. The survey includes detailed measures of substance use, mental health, and engagement with treatment and support services. Measures were identical across all included years. 35 For the current study, the sample was limited to pregnant females aged 12 to 49 years, yielding a final analytic sample of 2,051 participants which represented a population of 2,037,128.
Measures
Pregnancy
Every female respondent was asked the following question: “Are you currently pregnant?” Responses were categorized as 0 = no or 1 = yes.
Screening for Substance Use and Conversation About Treatment Options
Healthcare provider-initiated screening for substance use within the past 12 months was assessed using a single item from the NSDUH: “During the past 12 months, did any doctor or other healthcare professional ask, either in person or on a form, if you (a) drink alcohol? or (b) use marijuana or other illegal drugs?” Responses were coded as a binary variable (0 = not asked, 1 = asked). A conversation about treatment options and/or substance use was assessed using 2 items: “in the last 12 months, a ‘Doctor offered information about alcohol treatment’ or a ‘Healthcare professional discussed my drug use with me.’” Responses were coded as a binary variable (0 = no follow-up conversation, 1 = follow-up conversation).
Past-Year SUD
Past-year SUD was based on DSM-IV criteria used in the NSDUH, indicating abuse or dependence symptoms related to illicit drugs or the nonmedical use of prescription medications within the last 12 months (0 = no SUD, 1 = SUD).
Past-Year Substance Use Treatment
Among respondents with a SUD, receipt of any inpatient, residential, or outpatient SUD treatment in the last 12 months was coded as a binary variable (0 = none, 1 = any).
Mental Health Condition and Criminal Legal System Involvement
Any mental health condition was assessed through the Mental Health Surveillance Survey in the NSDUH, and a binary indicator was created (0 = no AMI, 1 = AMI). Past year criminal justice involvement (i.e., probation, parole, and/or being arrested and booked) was coded as a binary indicator (0 = none, 1 = any involvement).
Sociodemographic Variables
Sociodemographic variables were self-reported and included age, race/ethnicity, income level, educational attainment, insurance status, and county status.
Statistical Analysis
Statistical analyses were conducted in 3 phases. All estimates were computed following SAMHSA’s guidelines to account for the stratified cluster sample design and weights for the 3-year pooled dataset. 36 All estimates were restricted to pregnant women. First, estimates of the prevalence and characteristics of the sample who were screened for substance use in the last 12 months were calculated. Next, the proportion and characteristics of those in the sample who met criteria for a past-year SUD were estimated. For those with a past-year SUD, the proportion and characteristics of those who attended SUD treatment in the past year were estimated. Second, researchers fit 3 survey-weighted logistic regression models estimating the adjusted odds of (1) screening for substance use, (2) meeting DSM-IV criteria for SUD, and (3) receiving SUD treatment; results are reported as adjusted odds ratios (AORs) with 95% confidence intervals. All analyses were conducted using Stata version 19 37 using svy procedures.
Results
Prevalence and Characteristics of SUD Screening, SUD, Treatment for SUDs
Overall, 64.7% of pregnant women (n = 1,317,044) were screened for a SUD by a member of their healthcare team (Table 1). Among pregnant women who were screened, the largest proportions were aged 26 to 34 years (56.6%), White (60.7%), living at more than 2 times the poverty level (65.6%), college educated or higher (47.3%), living in a large metro area (57.2%), and had an alcohol-related SUD (38.3%). Among those screened, 14.3% met the criteria for a SUD in the last 12 months (Table 1).
Demographic Characteristics and Factors Associated With Screening and Meeting Diagnostic Criteria for SUDs Among Pregnant Women (N = 2,037,128).
Abbreviations: AOR, adjusted odds ratio; Ref, reference group; SUD, substance use disorder.
Percentages may not total 100% due to rounding.
Demographic characteristics of the subsamples of pregnant women screened for (n = 1,317,044) or met diagnostic criteria for a SUD (n = 291,990) in the past 12 months, respectively. Percentages represent subsample column percentages. b AORs from 2 separate multivariable logistic regression models conducted on the full analytic sample (N = 2,037,128) predicting the likelihood of SUD screening and diagnosis, respectively.
P < .001. **P < .01. *P < .05.
Among the 291,990 pregnant women meeting criteria for a SUD, only 10.0% (n = 29,119) received any SUD treatment in the past 12 months. The vast majority (72.7%, n = 21,170) of women meeting criteria for an SUD who received treatment reported being screened for substance use by a healthcare provider. Among pregnant women who received treatment, care settings were not mutually exclusive: 83.1% received outpatient care, 39.3% residential care, and 25.3% inpatient care.
Factors Associated With Screening, SUD, and Treatment for SUDs
Screening for Substance Use
Pregnant adolescents aged 12 to 15 were 20% (AOR = 0.8, 95% CI = 0.6-0.9) less likely to be screened for substance use in the last 12 months compared to women aged 35 to 49. Compared to White women, Black/African American women were 30% (AOR = 0.7, 95% CI = 0.5-0.7) less likely to be screened, Pacific Islander/Hawaiian were 40% (AOR = 0.6, 95% CI = 0.4-0.5) less likely to be screened, Asian women were 50% (AOR = 0.5, 95% CI = 0.4-0.5) less likely to be screened, and Hispanic/Latinx women were 30% (AOR = 0.7, 95% CI = 0.6-0.8) less likely to be screened; conversely, multiracial women were 90% (AOR = 1.9, 95% CI = 0.8-1.9) more likely to be screened. Pregnant women who were privately insured were 30% (AOR = 1.3, 95% CI 1.1-1.4) more likely to be screened compared to women with other insurance types and women with a co-occurring mental health condition were 90% (AOR = 1.9, 95% CI 1.8-2.0) more likely to be screened compared to women with no mental health condition (Table 2).
Factors Associated With Attending Substance Use Treatment Among Pregnant Women With a SUD.
Abbreviations: AOR, adjusted odds ratio; Ref, reference group; SUD, substance use disorder.
Percentages may not total 100% due to rounding.
P < .001. **P < .01. *P < .05.
Substance Use Disorders
Among all pregnant women with a SUD, alcohol and marijuana were the most common substances followed by opioids and polysubstance use, affecting nearly 1 in 4 women. Pregnant adolescents aged 12 to 15 years who had been screened for substance use were 50% (AOR = 0.5, 95% CI = 0.3-0.6) less likely to have a SUD in the past 12 months compared to women aged 35 to 49. Conversely, women aged 18 to 25 were 30% (AOR = 1.3, 95% CI = 1.1-1.4) more likely, and women aged 26 to 34 were 50% (AOR = 1.5, 95% CI = 1.3-1.6) more likely to have a SUD compared to women aged 35 to 49. Compared to White women, Native American/Alaskan Native women were 2.1 times more likely (AOR = 2.1, 95% CI = 1.3-3.5) and multiracial women were 30% (AOR = 1.3, 95% CI = 1.1-1.6) more likely to have a SUD. Uninsured pregnant women were 40% (AOR = 1.4, 95% CI = 1.2-1.6) more likely to have a SUD compared to those with insurance, while women with private insurance were 10% (AOR = 0.9, 95% CI = 0.8-1.0) less likely to have a SUD compared to women with other insurance types. Pregnant women with a co-occurring mental health disorder were 3.4 times more likely (AOR = 3.4, 95% CI = 3.1-3.6) to have a SUD compared to those without a mental health condition, and those with criminal justice involvement were 4.2 times more likely (AOR = 4.2, 95% CI = 3.3-5.2) to have a SUD compared to women without such involvement.
Pregnant Women With a SUD Who Attended Substance Use Treatment
While being screened for a SUD did not increase the odds of attending treatment for pregnant women with a SUD, a healthcare provider having a follow-up conversation with pregnant patients who screened positive greatly increased the odds of treatment engagement. Specifically, having such a follow-up conversation resulted in a 10.3 (AOR = 10.3, 95% CI = 1.2-84.8) times higher likelihood of attending SUD treatment. Compared to women aged 35 to 49 years old with a SUD, those between the ages of 26 to 34 were 12.8 (AOR = 12.8, 95% CI = 0.8-215.7) times more likely to attend SUD treatment. Compared to White women with a SUD, Hispanic/Latinx women were 90% less likely (AOR = 0.1, 95% CI = 0.1-0.6) to attend treatment. Educational attainment was strongly associated with treatment engagement. Pregnant women without insurance were 90% less likely (AOR = 0.1, 95% CI = 0.1-0.5) to attend treatment compared to insured women. Finally, women with a co-occurring SUD and mental health condition were 5.5 times more likely (AOR = 5.5, 95% CI = 1.5-20.7) to attend treatment compared to those without a mental health disorder.
Discussion
Using nationally representative survey data, this study contributes to the growing literature on addressing and treating perinatal SUDs by examining how screening during pregnancy, a critical entry point in the perinatal SUD care continuum, relates to subsequent engagement in specialized SUD treatment services. Findings highlight substantial attrition between screening and engagement in SUD treatment. Despite widespread recommendations for universal substance use screening during pregnancy,21,22,32 fewer than two-thirds of pregnant women in the nationally representative sample reported being asked about their use of drugs or alcohol. This prevalence is notably lower than estimates from a prior study, indicating that more than 80% of women are being screened for drug and/or alcohol use during prenatal care visits. 38 Furthermore, only 10% of the pregnant women in the sample who met criteria for a SUD reported receiving treatment during the past year—far lower than rates observed in the general population, where approximately 19.3% of individuals in need of SUD treatment report receiving it within the past year. 1 Together, these findings underscore persistent and substantial gaps in the continuum of care for pregnant women.
Universal substance use screening implies that every pregnant woman, regardless of her social status, educational level, race, or ethnicity, is asked about her use of drugs and alcohol during prenatal care appointments. This does not include formal screenings for SUDs, which remain rare in routine obstetric visits. However, consistent with prior research, study findings suggest that the ideal of universal screening is often not realized in practice, reflecting system-level gaps in how screening practices and policies are implemented and monitored within routine prenatal care.32,38 Similar to previous studies, we observed racial disparities in screening practices among pregnant women. However, whereas prior research has reported higher screening rates among women of color compared to White women,25,38 we found that Black/African American, Native American/Alaska Native, Pacific Islander/Native Hawaiian, Asian, and Hispanic/Latinx women had lower odds of being screened for drug and alcohol use during pregnancy, while multiracial women had nearly twice the odds of being screened as White women. As racial identities are complex, it is unclear why multiracial women in this sample reported higher rates of screening than other racially minoritized populations. The higher odds observed among multiracial women may reflect implicit racial bias that can influence patient-provider interactions rather than patient-reported need. 39 These findings underscore the importance of more granular examinations of race and screening practices, especially within the structural and organizational systems in which screening decisions are made. Other studies have similarly found that racially minoritized women are less likely to be screened: A recent national evaluation of screening practices among pregnant women found lower screening prevalence among American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiracial women compared to those identifying as Hispanic or Latino, non-Hispanic Black or African American, and non-Hispanic White. 32 Differences between the current findings and prior studies may be due to the variation in how screening is conducted (i.e., patient self-report versus standardized instrument) and differences in study populations across various time periods. Nonetheless, these findings suggest that screening practices vary across racial and ethnic groups, highlighting the need for further investigation to disentangle these patterns and the underlying mechanisms that drive them.
Pregnant adolescents were also significantly less likely to be screened compared to women aged 35 to 49. These lower rates of screening may be a result of the high rates of fragmented prenatal care often observed in this population, 40 discomfort in discussing sensitive information with a provider, 41 or heightened concerns about potential punitive legal consequences. 42 However, prior findings on age-related differences in screening practices are mixed. While some studies similarly report lower screening rates among younger women than their older counterparts, 32 other studies have demonstrated the opposite pattern, 38 underscoring the need for further research to clarify how age may impact screening practices, as well as the mechanisms driving these differences. Nevertheless, such disparities represent missed opportunities for early identification and intervention and may reflect broader inequities in perinatal healthcare access and/or delivery.
Screening practices also varied by socioeconomic and insurance-related factors. Women experiencing financial insecurity were screened at lower rates than women with higher incomes. Those with private insurance had higher odds of being screened than those without private insurance. Notably, fear of legal or child welfare involvement may reduce substance use disclosure among those with fewer socioeconomic resources, 42 which can shape patient-provider communication and screening practices.32,43 Furthermore, limited resources in safety-net settings (e.g., limited visit time, staff shortages, lack of integrated care) may represent organizational-level barriers that contribute to lower screening rates.44,45
This study also examined the characteristics of pregnant women with SUDs to identify risk factors and characteristics requiring special consideration for prevention and intervention services for this population. Consistent with prior research, higher rates of SUDs were found among women with comorbid mental health disorders 38 and those with criminal legal system involvement. 46 Given that women are one of the fastest-growing subpopulations within the criminal legal system, and that substance use represents one of the strongest risk factors for their entry into and continued risk of legal system involvement,47 -49 treatment programs that address the needs of pregnant people with SUD involved in the criminal legal system must be part of a broader strategy of improving care for all pregnant women with SUDs.50,51 Moreover, SUDs are rarely an isolated diagnosis; study findings mirror prior research suggesting that comorbid mental health SUDs are the norm rather than the exception 37 and alcohol, cannabis, opioid, and polysubstance-related disorders are prevalent during pregnancy. 52 This underscores the need for integrated, dual-diagnosis prevention and tailored intervention strategies during pregnancy (e.g., collocated behavioral health, medications for opioid disorder). Furthermore, Native American/Alaska Native and multiracial women also demonstrated disproportionately high odds of SUD. Yet, pregnant women of color encounter significant barriers impacting their access to and ability to complete substance use treatment compared to White women, highlighting the urgent need for culturally responsive, community-informed approaches to both prevention and treatment for these populations. 31
Critically, although most women reported receiving substance use screening, only 1 in 10 women who met SUD criteria received SUD treatment in the past year. The significant drop-off between SUD screening and receipt of treatment underscores a structural gap in the perinatal addiction care continuum (i.e., care coordination, referral infrastructure, and follow-up practices). Although universal screening is widely promoted as the essential starting point for identifying pregnant women with a SUD,19,18 little is known about what happens after screening and before treatment initiation, and few studies have evaluated whether efforts to promote universal screening are effective in actually identifying pregnant women in need of treatment services and successfully connecting them to those services.53,54 Study findings suggest that screening alone is insufficient.53,54 While screening alone did not significantly predict treatment engagement, a provider-initiated conversation about alcohol treatment options and/or a discussion about drug use was associated with a tenfold increase in treatment engagement, making it one of the strongest observed predictors of care entry. The magnitude of this association likely reflects multiple, overlapping factors. For example, initiating these conversations may itself promote greater recognition of a SUD. Alternatively, or in addition to this, pregnant women engaging in such discussions with their providers may themselves already be more ready to seek treatment and might have even initiated the conversation about treatment options. 55 Finally, discussions about treatment with healthcare providers may have been experienced by pregnant women as supportive, helping to reduce the stigma associated with SUDs, and clarifying available pathways to care. 56
These results suggest that follow-up conversations and coordination of services are necessary for improving treatment linkage to SUD treatment for pregnant women with SUDs. While research has supported the effectiveness of universal screening, brief intervention, and referral to treatment (SBIRT) as a strategy for connecting screening practices to subsequent engagement in treatment, practical barriers often interrupt its implementation in prenatal settings. 54 Importantly, while Medicaid reimburses for the use of SBIRT, this does not ensure consistent or effective implementation, and further training may have limited impact on provider implementation in the absence of larger system-level support. 57 Regardless of the payer, barriers to the implementation of the screening of substance use are well documented; these include limited time and competing priorities during prenatal visits, lack of training and support for healthcare professionals, and discomfort in discussing substance use during pregnancy. 54 Addressing these barriers will require increased focus on workflow redesign (e.g., creating time for follow-up conversations), strengthened workforce training and supports (e.g., continuing education on perinatal SUD), and an effort to promote greater accessibility and availability of culturally and gender-responsive care.58,59
Equally important are coordinated follow-up models that actively link patients to care through integrating obstetric care with behavioral health service delivery. 54 The majority of research on behavioral health integration has focused on primary care, but integrated behavioral health in obstetric settings also has significant evidence.60,61 Research on such models has found that integrating obstetric and behavioral health teams creates a system-level infrastructure with swift follow-up after positive substance perinatal substance use screens, clear communication between the care team, streamlined referrals to treatment, and the necessary ancillary support for the perinatal population (e.g., telehealth, transportation assistance). 54 In all, 12 states have implemented similar approaches, demonstrating growing recognition that what occurs after screening, rather than screening alone, ultimately determines treatment access and continuity of care. 57 Taken together, these findings point to the disparities observed in the continuum of care from screening to treatment engagement are best understood as system-, organizational-, and policy-level barriers within perinatal care delivery, rather than individual-level shortcomings of pregnant women or their healthcare providers.
Limitations
These study findings should be interpreted in light of several limitations. First, although the use of self-report data to assess pregnancy status is considered to have valid and reliable psychometric properties, 62 this study’s reliance on self-report measures alone and the exclusion of those institutionalized or experiencing homelessness may have led to underestimation of the true prevalence of substance use and SUDs in this population. Furthermore, respondents’ self-reports on the occurrence of screening may underestimate the proportion of those screened for SUD during prenatal care. Prior research has shown that pregnant women may underreport substance use due to stigma and fear of legal consequences. 42 Consequently, the true prevalence of SUDs among pregnant women reported in the current study may be underestimated.
Second, the NSDUH data from 2021 to 2023 were exploratory and pooled to increase the analytic sample size; findings may reflect Type I error, and the cross-sectional design of this survey precludes causal inference regarding the relationships between SUD screening and treatment receipt. Third, although several subgroup analyses, such as race and ethnicity, were statistically significant, they were accompanied by wide confidence intervals, likely due to the small sample sizes of subgroups and or use of complex survey weighting procedures. 63 Fourth, NSDUH measures of substance use and other behavioral domains (e.g., mental health) are based on a 12-month timeframe, which extends beyond the duration of pregnancy. Thus, it is likely that this study’s analysis included women with SUDs that occurred prior to conception. However, given that SUDs are chronic, relapsing conditions and that pregnancy alone does not guarantee cessation, identification of SUD and treatment engagement, even in the months preceding pregnancy, remain a clinically meaningful outcomes. 64
Implications for Policy and Future Research
Findings from this study highlight several important opportunities to bolster care for pregnant women with SUD at both the policy and research levels. First, the attrition in the care continuum between screening and treatment engagement underscores the need to shift policy efforts beyond the promotion of universal screening and towards meaningful follow-up that occurs after a positive substance use screen. Policies that incentivize models of integrated obstetric and behavioral health, facilitate care coordination (such as collaborative care models), 50 and fund roles such as perinatal navigators 51 may lead to timely referrals and successful treatment initiation. Second, this study demonstrated a need to invest in training for obstetric and primary care clinicians in both perinatal substance use and trauma-informed care, and to support culturally and gender-responsive care approaches. Third, public and private payors, especially Medicaid, should support flexible, low-barrier treatment options such as telehealth, peer support, and wraparound services. Moreover, longitudinal and mixed-methods studies should explore post-treatment outcomes, how pregnant women navigate the care pathway, and what interventions best promote continuity of care. This paper underscores the need to strengthen the perinatal substance use care continuum through interventions that support clinicians, reduce system-wide barriers, and establish integrated systems so that identification of SUDs and treatment are timely. These efforts are essential for improving maternal health outcomes and advancing equity in perinatal behavioral healthcare.
Footnotes
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number U81HP46529 Cooperative Agreement for a Regional Center for Health Workforce Studies for $1,121,875. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by SAMHSA, HRSA, HHS, or the US Government.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.