Psychosocial Interventions for Substance Using Women in the Perinatal Period: A Systematic Review of the Evidence

Background and Purpose: Perinatal substance use can have deleterious effects on maternal health outcomes, including increased postpartum depression, suicide, and overdose. While substance use treatment (SUDT) and medication are frontline interventions for perinatal substance use, effectiveness has been improved with psychosocial interventions (PSIs). This review updated previous reviews by adding more recently published studies of PSIs for pregnant substance using women. The following research questions were answered: 1) What types of PSIs for pregnant substance using women have been used to improve maternal health outcomes?; 2) What are the common outcomes across these studies?; 3) What are the methodological strengths and weaknesses of these studies?; 4) What interventions are most effective given the methodological rigor of the study?

Methods: A systematic search of four databases was conducted to identify studies that evaluated PSIs to improve maternal health among pregnant substance using women. Inclusion criteria were: 1) written in English; 2) published between 2000 and 2021; 3) conducted in North America; 4) included maternal health outcomes. The 11-item Methodological Quality Rating Scale was used to assess study rigor with possible total scores ranging from 0-15. Studies that scored equal to or above the mean were considered high rigor and those below were low rigor. To determine the strength of the evidence for each intervention, outcome significance was combined with study rigor as follows: 1) strong evidence (high rigor and significant outcomes); 2) promising (low rigor and significant outcomes); 3) weak evidence (high and low rigor and non-significant outcomes).

Results: Nine studies met the criteria for inclusion. Interventions included a combination of one or more of the following: case management, patient navigation, psychoeducation, and psychotherapy techniques (i.e., motivational interviewing, and mindfulness). The most common outcomes were substance use reduction (n=4), mental health (n=4), and enrollment and retention into SUDT (n=4). Methodological rigor was mixed with 44% scoring above the mean (M=8.9, SD=2.5). Methodological strengths included treatment fidelity, measurement reliability/validity, intervention dosage, attrition, and statistical analyses. Weaknesses included weak study designs, theoretical foundation, and follow-up length. Among studies that assessed substance use reduction, three of four (75%) provided strong or promising evidence of effectiveness, while one of four (25%) provided weak evidence. Two of the interventions with strong or promising evidence for reducing substance use included case management paired with motivational interviewing. All four (100%) studies that assessed mental health provided strong or promising evidence of effectiveness. Interventions with strong or promising evidence for improving mental health were case management paired with psychotherapy. All four (100%) studies that assessed SUDT enrollment and retention provided strong or promising evidence of effectiveness. Interventions with strong or promising evidence for enrollment and retention focused on accessing SUDT through case management.

Conclusion and Implications: Findings of this study suggest that PSI are generally effective at improving substance use, treatment retention, and mental health. Future research is needed to specify which combinations of psychosocial interventions work best to improve outcomes for substance using women during the perinatal period.