Effects of individual, health system and neighborhood risks on diabetes health outcomes among emerging adults with type 1 diabetes.

Overdose is a leading cause of maternal mortality in the United States (; , pp. 2017–2019), predominately driven by rising overdose deaths related to synthetic opioid use during pregnancy or within the first year postpartum (; ; ; ). Between 2016 and 2021, pregnancy-associated overdose mortality increased by approximately 60%, rising from 6.56 to 12.7 deaths per 100,000 individuals. National data showed opioid use disorder (OUD) also more than tripled among pregnant women, rising from 3.5 cases per 1000 delivery hospitalizations in 2011 to 9.3 per 1000 deliveries in 2018 (). Pregnant and postpartum women (PPW) continue to face substantive barriers to overdose prevention and OUD treatment due to structural and individual factors. On a systemic level, access is hindered by the limited availability of services equipped to care for PPW with OUD, the siloing of obstetric and substance use services, and fears of legal repercussions or custody loss for disclosing SUD needs (; ; ; ). At the individual level, co-occurring mental health conditions, stigma, and feelings of guilt and shame further challenge engagement with care (). Barriers are exacerbated among racialized PPW who experience increased stigma, discrimination, and punitive consequences of engaging in health systems like child protection service involvement and child removal, and who already bear the brunt of pregnancy-related complications and fatalities (; ; ). At the same time, pregnancy and parenting can also serve as powerful catalysts for positive behavior change including OUD treatment engagement (; ). Therefore, increasing access to and the quality of OUD services is critical as part of the strategy to reduce overdose rates among PPW. Despite the growing needs of PPW with OUD, PPW remain under-represented in opioid research, and knowledge gaps on how to implement and scale tailored programs persist. This is evidenced by marginal increases in the number of OUD services designed for PPW over the past decade, leading to persistent gaps in care (). For example, less than half of pregnant women with OUD receive medications for opioid use disorder (MOUD), the standard of care for OUD treatment, and among those who do, roughly a third discontinue treatment postpartum (; ; ). Overdose risk is highest during the postpartum period, related in part to treatment discontinuation, termination of insurance coverage, competing demands of caring for a new family, and child custody removal (; ; ). Increasing and scaling services is important as evidence shows that programs designed to meet the specific needs of PPW reduce access barriers and increase engagement with OUD treatment and prenatal care (; ; ). Examples of such tailored programming include integrated OUD treatment with prenatal care and/or providing childcare in OUD treatment services (; ). However, there remains a dearth of research focused on how to tailor and implement evidence-based interventions, such as overdose education and naloxone distribution (OEND) and MOUD, for PPW. In recognition of the specific needs of PPW and the call for increasing evidence-based interventions that meet these needs, PPW were classified as a “special population” within the HEALing Communities Study (HCS), the largest implementation science research project focused on curbing opioid overdose fatalities to date (). From 2019–2023, HCS coalitions in 66 communities across Kentucky (KY), Massachusetts (MA), New York (NY), and Ohio (OH) selected and worked with partner organizations to implement evidence-based practice (EBP) strategies to reduce opioid overdose deaths (). Community coalitions selected EBP strategies based on local data related to opioid overdose, existing overdose prevention and treatment resources, and service gaps (). EBP selection and delivery approaches were summarized in local action and implementation plans, including efforts to reach special populations (; Wu et al., 2020). From 2018 to 2022, maternal mortality rates in KY, MA, NY, and OH were 34.6% (95% CI: 27.9–42.5), 16.4% (95% CI: 12.4–21.3), 22.4% (95% CI: 19.6–25.2), and 24.5% (95% CI: 20.7–28.3), respectively (; ). During the same period, overdose-related maternal deaths accounted for 23.5% in KY, 27.7% in MA, 25.0% in NY, and 35.0% in OH (). In this study, we describe the number and types of EBP strategies explicitly intended to reach PPW that were selected and implemented by HCS communities in Massachusetts, New York, and Ohio. We also share lessons learned from efforts to deliver OEND and MOUD services to PPW.