Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial

Constance Guille, Annie N Simpson, Edie Douglas, Lisa Boyars, Kathryn Cristaldi, James McElligott, Donna Johnson, Kathleen Brady, Constance Guille, Annie N Simpson, Edie Douglas, Lisa Boyars, Kathryn Cristaldi, James McElligott, Donna Johnson, Kathleen Brady

Abstract

Importance: There are high rates of maternal and newborn morbidity and mortality associated with opioid use disorder (OUD). Integrating OUD treatment in obstetric practices for pregnant and postpartum women via telemedicine can increase access to care and reduce the consequences of OUD. Evaluation of this care delivery model, however, is needed before widespread adoption.

Objective: To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person.

Design, setting, and participants: A nonrandomized controlled trial including 98 women receiving perinatal OUD treatment in 4 outpatient obstetric practices by telemedicine or in person and followed up until 6 to 8 weeks post partum was conducted from September 4, 2017, to December 31, 2018. Logistic regression with propensity score adjustment was applied to reduce group selection bias and control for potentially confounding variables.

Interventions: Participants were seen weekly for 4 weeks, every 2 weeks for 4 weeks, and monthly thereafter and provided relapse prevention therapy and buprenorphine.

Main outcomes and measures: The outcomes were retention in treatment, defined as uninterrupted addiction treatment during pregnancy through 6 to 8 weeks post partum; urine drug screen results at delivery and 6 to 8 weeks post partum; and a neonatal abstinence syndrome (NAS) diagnosis collected via electronic health records.

Results: The mean (SD) age of the 98 pregnant women was 30.23 (5.12) years. Of these, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group chose to continue treatment in the program after an initial evaluation. After propensity score weighting and doubly robust estimation, no significant differences were found between groups in retention in treatment at 6 to 8 weeks post partum (telemedicine: 80.4% vs in person: 92.7%; treatment effect, -12.2%; 95% CI, -32.3% to -4.4%). Similarly, after propensity score weighting and doubly robust estimation, there were no significant group differences in rates of NAS (telemedicine: 45.4% vs in person: 63.2%; treatment effect, -17.8%; 95% CI, -41.0% to 8.9%).

Conclusions and relevance: In this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care. These findings may have important public health implications for combatting the opioid crisis and its consequences on pregnant women and their families. Future large randomized clinical trials are needed.

Clinical trial registration: ClinicalTrials.gov identifier: NCT04049032.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Guille reported receiving grants from Duke Endowment, grants from the Health Resources and Services Administration, and grants from the National Institute on Drug Abuse during the conduct of the study. Dr Simpson reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Cristaldi reported receiving grants from the Health Resources and Services Administration National Telehealth Center of Excellence outside the submitted work. Dr Brady reported receiving grants from State of South Carolina during the conduct of the study. No other disclosures were reported.

Figures

Figure.. Flow Diagram of Study Participants
Figure.. Flow Diagram of Study Participants
OUD indicates opioid use disorder.

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