MAT Engagement in Pregnancy: The Role of Social Determinants

Background: Mothers face distinct challenges in accessing SUD treatment beyond common barriers, they experience unique stressors including lack of affordable childcare, transportation problems, social isolation, and relationship instability, all significantly hindering treatment access and engagement (Boeri et al., 2021). In 2020, there were about 12 pregnancy-associated overdose deaths for every 100,000 births, a 46% spike in one year and an 81% increase since 2017 (Bruzelius, 2022). Methadone and buprenorphine are first-line therapy options for pregnant women with OUD, as recognized by ACOG and SAMHSA (CDC, 2024). This study aims to determine whether specific social determinants of health (SDOH) predict a pregnant individual's intention to access MAT upon treatment admission.

Methods: Data for this study was obtained from the Treatment Episode Data Set in 2022 (TEDS-A), maintained by Substance Abuse and Mental Health Services Administration (SAMHSA). The sample includes individuals identified as pregnant on admission to treatment (N=11,491). The dependent variable, planning to access MAT during treatment, is dichotomous (1=yes, 0=no). The independent variables in this study are income, employment, education, and housing, while controlling for race and primary substance of use. Chi-square tests and logistical regression were performed to assess the relationship between each of the selected socioeconomic variables (income source, employment status, educational attainment, and housing arrangement) and the outcome of planned MAT initiation in the study sample.

Results: The study included 11,491 pregnant individuals with substance use disorder (SUD), with most participants identified as White (66%). At admission, 28% of participants expressed a desire to initiate MAT. Socioeconomic data showed that 42% of participants reported no primary income, 43% were unemployed, and 48% had a high school diploma or GED. Logistic regression results largely corroborate the patterns observed, indicating that individuals relying on public assistance, living independently, or with a high school diploma were approximately 2 times more likely to plan to access MAT in treatment. Participants possessing four or more years of college demonstrate an even higher likelihood, being 2.5 times more likely to plan to initiate MAT in treatment.

Discussion: A key finding is that the majority of pregnant individuals entering treatment did not plan to utilize MAT (72%). In contrast, those who did intend to access MAT were more frequently unemployed (32%) and receiving public assistance (38%). The data strongly suggests that employed pregnant individuals with wages represent the most likely group to not access treatment (78% and 82%), highlighting a potentially overlooked vulnerable population for MAT. The data only includes individuals who have sought and been admitted to substance abuse treatment facilities, this means the sample is not representative of all individuals with SUD in the general population. Future research needs to focus on the specific barriers that employed individuals encounter when seeking treatment, including employment-related challenges and the impact of being underinsured.