Interventions for opioid use disorder during the first year postpartum: A systematic review.

Severe maternal morbidity (SMM) events are defined by the CDC as unexpected outcomes during delivery hospitalizations that result in substantial consequences to maternal health, encompassing 21 indicators across cardiovascular complications, severe systemic complications, and morbidities requiring emergency procedures []. In the United States, the prevalence of SMM events has been increasing over the past several years, which has effects on both the individual patient and their family, along with the healthcare system and national healthcare costs []. Those without substance use disorder (SUD) have rates of SMM events around 1.99% versus 3.14% in those with SUD []. SMM events are often precursors or coincide with maternal mortality, and rates of maternal mortality have been steadily increasing in the United States []. A total of 16.5% of the population in the United States age 12 or older met criteria for having SUD in 2021 []. A national survey in the United States in 2020 revealed that approximately 8% of pregnant people reported using illicit drugs []. In addition, SUD in pregnancy has been associated with adverse outcomes for both pregnant people and their neonates []. Understanding the risk factors for SMM is crucial for decreasing the rates of these events among vulnerable patient populations, such as pregnant patients with SUD—an at‐risk cohort identified as having a higher risk for experiencing an SMM event []. Of note, women with opioid use disorder (OUD) have been shown to have higher rates of SMM events []. However, over the past decade, exclusive opioid use is becoming rarer and those with OUD are more likely to be concurrently using another substance illicitly such as stimulants (e.g., concurrent OUD and methamphetamine use disorder) []. Given the increasing prevalence of stimulant use in general as well as stimulant use in the perinatal context [], elucidating the differential impact of opioid and stimulant use versus co‐occurring stimulant and opioid use on SMM is critical for risk stratification and patient counseling.