A mixed methods systematic review of interventions for women in the perinatal period, who are dependent on drugs
Background: Women who use drugs during the perinatal period have complex health and social care needs including histories of abuse, poor mental health, and social exclusion. Substance use in pregnancy is thus multifaceted with many confounding factors that may impact the long-term health and wellbeing of both mothers and children. While women who use drugs require maternity care and frequently have co-existing physical and/or mental health problems, they often do not ‘fit’ into standard care pathways. Additional evidence is needed to see what interventions are effective for this population.
Methods: A Mixed Method Systematic Review was conducted to describe the range of interventions available for women who use drugs perinatally, identify evidence for intervention effectiveness, and to identify interventions that women feel meet their needs. Following a predetermined protocol, eight databases were searched for articles meeting the inclusion criteria. The search was limited to include articles published after 1990, and available in the English language. 192 articles were included in the review following screening by four reviewers. A data extraction template was used to extract study characteristics and results, assessing quality using the Mixed Method Quality Appraisal Tool. Cohen’s D was used to measure effect size for the quantitative data, and for the qualitative data, articles were grouped together by intervention type and the authors themes thematically analysed. Narrative synthesis was then used to consider these findings collectively.
Results: A total of 192 studies describing 211 interventions were included within the review. The most frequent intervention type reported were psychosocial, health and practical support (23.23%) followed by psychosocial only (14.21%) and interventions that included psychosocial, pharmacological, practical support, and health elements (11.37%). Most interventions (85.30%) were community-based, delivered in more than one way (69.66%), and delivered in single settings (52.13%), although some were co-located alongside other services (21.33%). Analysis of the quantitative data demonstrated no conclusive findings related to a single intervention’s effectiveness although most interventions that improved engagement and retention in substance use services were integrated and co-located with practical support elements. The qualitative synthesis supports this and suggests that women appreciate being able to access multiple services in one place and that they value a non-judgemental, trauma informed approach from the individuals providing their care.
Conclusions: This review found that there was strong evidence in both quantitative and qualitative studies to suggest that integrated, one-stop shop services reduce drug use and increase engagement. Further high-quality research that identifies how to effectively engage women in substance use treatment and maternity care in the perinatal period is urgently needed.
