Working with States, Federal Partners, and National Organizations to Improve Outcomes for Pregnant and Postpartum Women with Opioid Use Disorder

As part of CDC’s five-point strategy to prevent opioid overdoses and harms, the Division of Reproductive Health (DRH) is working to prevent, identify, and improve access to treatment of opioid use disorder (OUD) among pregnant and postpartum women and women of reproductive age. Learn more about opioid use during pregnancy.

Overview

Opioid misuse and overdose can be particularly devastating for mothers and infants during pregnancy and the first year after birth. CDC’s Division of Reproductive Health (DRH) is collaborating with states, federal partners, and national organizations to:

• Better understand opioid use and risks among pregnant and postpartum women, maternal overdose deaths, and related state needs.
• Support health systems to improve the care of pregnant and postpartum women with opioid use disorder and infants with neonatal abstinence syndrome (NAS).

CDC’s National Center for Injury Prevention and Control funds two DRH projects to improve outcomes for pregnant and postpartum moms with opioid use disorder:

• Rapid Assessment of Maternal Opioid Use and Overdose to Improve Outcomes and Save Lives
• Improving Quality of Care for Pregnant and Postpartum Women With Opioid Use Disorder

DRH Projects

Rapid Assessment of Maternal Opioid Use and Overdose to Improve Outcomes and Save Lives

The Pregnancy Risk Assessment Monitoring System (PRAMS) Opioid Supplement and Call-Back Survey will use the existing PRAMS infrastructure to identify sociodemographic and behavioral risks associated with opioid use and misuse around the time of pregnancy. Data from this survey will help state health departments, clinical health providers, CDC, and other federal agencies develop programs and policies to reduce the risk of opioid exposure during pregnancy and ensure access to recommended clinical care. Learn more about PRAMS.

As part of this effort:

• 32 states received funding to add a set of supplemental questions on opioid use and misuse to their PRAMS survey. The resulting data will be used to identify community needs, policy gaps, and best practices for reducing maternal opioid misuse and overdose deaths. Data collection began in April 2019.
• California and Ohio will use their existing maternal and child health surveillance systems to collect the same data collected on the PRAMS opioid supplement survey.
• 7 states with a high rate of opioid-related overdose deaths received funding for a call‐back survey of previously interviewed mothers at 9 months postpartum. This survey will assess opioid misuse and access to medication-assisted therapy, satisfaction with care received, postpartum care received, infant health and development, and receipt of social services and supports. Data collection will begin October 2019.

Rapid Maternal Overdose Review (RMOR) supports five state Maternal Mortality Review Committees to review all pregnancy-associated overdose deaths in their state.  Maternal Mortality Review Committees get the most detailed, comprehensive data on maternal deaths. Through RMOR, CDC is also developing processes and tools that committees can use to improve data quality and collection to better capture, analyze, and prevent maternal overdose deaths. Data from this effort will be used to develop recommendations for prevention. Learn more about Maternal Mortality Review Committees.

The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) is a collaborative Learning Community that shares strategies and best practices for policies and programs designed to improve the identification and treatment of pregnant and postpartum women with opioid use disorder and infants prenatally exposed to opioids. Thirteen state teams—that consist of state health officials; Title V directors; behavioral, mental health, or alcohol and drug abuse directors; Medicaid medical directors; and provider or facility champions—are participating in the initiative.

Learning Community supports include:

• Virtual learning sessions, peer-to-peer conference calls, mentoring, and technical assistance calls and resources.
• Technical assistance support from CDC, ASTHO, other federal partners, and leading experts in substance use disorders throughout the country.
• Targeted field support in up to five participating states to enhance their ability to develop and put into action the goals outlined in their OMNI state plans.

Improving Quality of Care for Pregnant and Postpartum Women with Opioid Use Disorder

Perinatal Quality Collaboratives (PQCs) are state or multistate networks of multidisciplinary teams working to improve the health of mothers and infants. PQCs address gaps in care by working with clinical teams, experts, and stakeholders—including patients and families—to use best practices and make the best use of resources to improve perinatal care and outcomes. CDC is currently supporting 13 state-based PQCs and the National Network of Perinatal Quality Collaborativesexternal icon to share lessons learned with other PQCs across the country.

In 2019, supplemental funding was available to expand the work of existing CDC-funded PQCs to improve quality of care and outcomes for pregnant and postpartum women with opioid use disorder and newborns with NAS. This funding will support training and help states build their capacity to use best practices for screening, treating, and coordinating care for these at-risk populations. Funded states will be announced in September 2019. Learn more about PQCs.