Table 2.

Characteristics of included studies

Study	Referral, Access, Retention, Or Effectiveness	Population Focus	Study Setting, Sample Size	Gateway or Referral source	Type of Substance Use Disorder	Study Design	Objective(s)	Key Results
Alemi et al., 199642	Effectiveness	Pregnant women	Clinical setting, not specified (n=179)	Health care provider, not specified	Cocaine	Prospective cohort; Qualitative interview	Assess the intervention that used computer services to inform and motivate patients	• The intervention did not lead to significant change in patients’ health status, drug use, or utilization of services; however, it did increase SUD treatment engagement • SUD treatment engagement did not reduce drug or alcohol use
Messer et al., 199648	Access	Pregnant women	Prenatal care clinic (n=182)	Health care provider	Alcohol or other drugs	Cross-sectional	Explore the characteristics of pregnant women who used SUD treatment service vs. women who declined to participate	• 51% of eligible pregnant women participated in the SUD treatment service • Among women with low SES, Black women, women with more children, women with greater severity of SUD, individuals who use cocaine, and women who have previously received SUD treatment were more likely to participate in this SUD treatment service
Klein and Zahnd, 199722	Referral; Access	Pregnant women	Public agencies and community organizations (n=401)	Families with Dependent Children, health clinics, SNAP, refuges, jails, and programs for teenagers	Alcohol or other drugs	Qualitative interview	Explore alcohol and drug use patterns, and problems and unmet service needs (including treatment)	• More than half of the sample came from the Aid to Families with Dependent Children (AFDC), followed by health clinics, SNAP, and refuges, jails, and programs for teenagers • The following service needs were found: job placement, educational programs, and housing • 64% had not participated in formal treatment or 12 step program • Among women who were not in treatment, they did not want treatment due to: financial barriers, legal problems, did not know what treatment was available/how to get into treatment, and/or had no transportation or child care.
Whiteside et al., 199940	Effectiveness	Pregnant women and mothers	SUD treatment (n=105)	N/A	Alcohol or other drugs	Prospective cohort	Assess the Arkansas Center for Addictions Research, Education, and Services (AR-CARES)	• The AR-CARES evolved over a 5-year period and responded to the needs of the target population (pregnant women and parenting women with SUD) • Added residential facilities, mental health counseling, child care, early intervention for children, and transportation to the treatment program • Decreased maternal substance use and lowered incidence of premature labor and maternal infections
Weisdorf et al., 199945	Retention; Effectiveness	Pregnant women	SUD treatment (n=500)	N/A	Cocaine	Retro-spective cohort	Evaluate the Pregnancy Substance Abuse Program (PSAP)	• The PSAP increased treatment retention • Successful factors include: counselor continuity, treatment coordination and group continuity across levels of care, pregnancy and women specific treatment groups, child-care options, and increased emphasis on outpatient treatment
Kissin et al., 200149	Access	Pregnant women	SUD treatment (n=240)	Social services	Opioid or cocaine	Cross-sectional	Explore the characteristics of pregnant women in SUD treatment	• Participants were likely to be Black, low income, urban women with opioid use disorder in their late twenties who voluntarily entered treatment • They were surrounded by others, often family members, with substance use disorder problems • They were less likely to have a full-time employment and many received income from the Department of Social Services
Nishimoto et al., 200138	Retention	Pregnant women and Mothers	SUD treatment (n=252)	Child Protective Services (CPS), local hospitals, social services, self-referrals	Alcohol or other drugs	Randomized controlled trial	Examine the relationship between various indicators of coercion and treatment retention and whether those relationships vary by treatment modality	• 83% of the sample were referred from the CPS; 8% from local hospitals; 6% from social agencies; 2.8% were self-referrals • Women who had custody were more likely to stay in treatment compared to women who did not have custody
Hohman et al., 200320	Referral	Pregnant women	SUD treatment (n=678)	CPS	Alcohol or other drugs	Retro-spective cohort	Describe the demographic, substance use, and treatment variables and to compare these variables based on CPS status	• Mandated status, unsatisfactory exit status, and cocaine use were associated with CPS referrals • CPS has additional requirements beyond the treatment requirements
Tuten et al., 200350	Retention	Pregnant women	SUD treatment (n=235)	Social services	Alcohol or other drugs	Cross-sectional	Compare homeless and domiciled pregnant women with SUD on treatment outcomes	• Homeless women with SUD had lower retention rates, received only 65% of the social services income compared to domiciled women • Homeless pregnant women with SUD may be lacking resources compared to domiciled women
Grella et al., 2006 21	Referral	Mothers	SUD treatment (n=4,156)	Healthcare provider, CPS, social services, employer	Alcohol or other drugs	Cross-sectional	Compare the characteristics of mothers in treatment who were and were not involved with child welfare services	• Women engaged in child welfare services were younger, had more children, had lower levels of addiction severity, but were more likely to be economically unstable compared to women not engaged in child welfare services • Women who were involved with child welfare services were less likely to cite an individual (i.e., self, family, or friends) or another treatment provider as the source of referral to treatment, and had a higher rate of being referred by another organization or service provider (i.e., health care provider, child welfare, social services, employer)
Conners et al., 2006 41	Retention; Effectiveness	Pregnant women and mothers	SUD treatment (n=305)	Criminal justice system	Alcohol or other drugs	Prospective cohort	Evaluate AR-CARES program on women in the areas of substance use, consequences of use, employment, legal involvement, mental health symptoms, risky sexual behavior, and parenting attitudes.	• AR-CARES improved LOS and resulted in positive outcomes (lower substance use, higher self-sufficiency, improved parenting attitudes, and fewer symptoms of depression and PTSD) • About 33% of women were legally pressured to enter treatment • Most women entered treatment with a criminal record, and more than half (59.5%) were arrested in the year before intake, a quarter (24.3%) were rearrested after treatment
Pollack & Reuter, 2006 23	Referral; Effectiveness	Pregnant women and mothers	National Survey	CPS, social services	Alcohol or other drugs	Retro-spective cohort	Evaluate the association between welfare receipt and treatment	• Welfare settings are important access points to treatment for low-income women (Temporary Assistance for Needy Families (TANF))
O’Connor & Whaley, 2007 18	Effectiveness; Referral	Pregnant women	Supplemental Nutrition Program (n=255)	Social services, Community programs	Alcohol	Randomized controlled trial	Examine the efficacy of brief intervention	• Brief intervention by nonmedical professionals (i.e., nutritionists) successfully increased pregnant women’s motivation to change alcohol drinking behavior • Community programs like Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children (SNAP-WIC) can be instrumental in preventing alcohol-exposed pregnancies
Simons, 2008 37	Retention	Pregnant women and mothers	SUD treatment (n=80)	N/A	Alcohol or other drugs	Retro-spective cohort	Measure differences in characteristics and outcomes between treatment completers versus non-completers	• Women who completed treatment had higher rates of alcohol consumption, arrests for public intoxication, family support, lower mental health problems, higher rates of childhood emotional neglect, and higher rates of medication. • Mental health comorbidity is a big barrier to treatment completion, especially among Black women
Morgenstern et al., 2009 19	Effectiveness; Referral	Mothers	Temporary Assistance for Needy Families (TANF) (n=452)	Social services	Alcohol or other drugs	Randomized controlled trial	Evaluate the impact of intensive case management program among women with SUD receiving TANF.	• Intensive case management program increased abstinence rates through 24 months of follow-up, and improved full-time employment rates among women receiving TANF • Treatment likely improves abstinence, which impacts later employment
Dakof et al., 2010 31	Effectiveness	Mothers	Drug court, (n=62)	Criminal justice system, CPS	Alcohol or other drugs	Randomized controlled trial	Evaluate the Engaging Moms Program (EMP) intervention	• EMP increased the likelihood of positive child welfare dispositions • Decreased substance use • Increased family functioning and enhanced parenting practices • Improved maternal mental and physical health
Ondersma et al., 2010 36	Retention	Pregnant women	SUD treatment, (n=200)	N/A	Alcohol or other drugs	Randomized controlled trial	Analyze external pressure on retention in treatment and substance use	• Pregnant women who had external pressure were more likely to remain in treatment, attend more treatment sessions, less likely to use substances (less tested positive or report fewer days of use)
Jackson and Shannon, 2012 27	Access	Pregnant women	Tertiary hospital, detox (n=85)	Health care provider	Alcohol or other drugs	Cross-sectional	Identify barriers to treatment	• Over 80% of the sample reporting having experienced any barrier to treatment and the majority indicated having more than two barriers • The majority experienced acceptability and accessibility barriers
McCabe et al., 2012 26	Access	Pregnant women	SUD treatment, (n=1,724,479)	Criminal justice system, health care provider	Alcohol or other drugs	Repeated cross-sectional	Characterize pregnant women entering SUD treatment	• Pregnant women were more likely to be younger, minority, never married, less educated, homeless, on public-assistance or have no income than nonpregnant women
Meyer et al., 2012 43	Effectiveness	Pregnant women	Tertiary hospital, (n=149)	Health care provider	Opioids	Cross-sectional	Determine whether increased access to medication for opioid use disorder and improved coordination of ancillary services for pregnant women improved perinatal outcomes	• The number of pregnant women receiving treatment increased • Improved maternal and perinatal outcome in the nonurban setting • Development of coordinated team care may improve outcomes
Thompson et al., 2013 12	Access	Mothers	CPS, (n=27)	CPS	Alcohol or other drugs	Qualitative interview	Evaluate the perspective of participants in the Parenting in Recovery (PIR) program	• Motivations behind participation include 1) the program would allow them to keep their children or be reunited with their children more quickly 2) to avoid a criminal investigation, arrest or jail
Kuo et al., 2013 13	Access; Retention	Pregnant women and mothers	SUD treatment, (n=18)	Social services, CPS	Alcohol or other drugs	Qualitative interview	Explore factors impacting treatment outcomes and needs	• Self-motivation, pregnancy, navigating family relationships, availability of community support (support groups and program for outpatient treatment) can facilitate treatment • Social support does not always facilitate treatment; agencies like Department of Children, Youth, and Their Families (DCYF) can be facilitative or challenging • Programs that address dual-diagnoses are promising
Aklin et al., 2014 34	Effectiveness	Pregnant women and mothers	SUD treatment, (n=40)	N/A	Opioids, cocaine	Randomized controlled trial	Evaluate the effects of a therapeutic workplace social business on drug abstinence and employment	• More cocaine- and opiate- negative urine samples than controls • Less money spent on drugs • More days employed • Higher employment income
Lee King et al., 2015 10	Access; Retention	Pregnant women	Primary care, (n=2,729)	Health care provider	Alcohol or other drugs	Cross-sectional	Determine clinical profiles of pregnant women in treatment for co-occurring disorders with current interpersonal abuse	• Pregnant women more likely to demonstrate social vulnerability than nonpregnant women • Less income
Stone, 2015 14	Referral; Access	Pregnant women and mothers	Community (Multiple settings including transportation hubs and healthcare settings) (n=30)	N/A	Alcohol or other drugs	Qualitative interview	Explore the experiences of substance-using mothers in health and criminal justice settings	• Women managed their risk of detection by health or criminal justice authorities, including isolating themselves from others, skipping treatment appointments, or avoiding treatment altogether
Angelotta et al., 2016 24	Access; Referral	Pregnant women	SUD treatment, (n=8,292)	Individual, Health care provider, Criminal justice system, Community	Opioids	Repeated cross-sectional	Analyze the relationship between the use of medication for opioid use disorder (MOUD) and state laws that criminalize substance use during pregnancy	• Half of pregnant women with opioid use disorder received MOUD • Pregnant women referred to treatment by the criminal justice system were least likely to receive MOUD
Kahn et al., 2017 29	Effectiveness	Pregnant women and mothers	SUD treatment, (n=75)	N/A	Opioids	Qualitative interview	Evaluate parenting education at MAT clinic	• Educational content was useful • Participants appreciated the social support provided by the groups
Mittal et al., 2017 5	Effectiveness	Pregnant women	Obstetric clinic, (n=14)	Health care provider	Opioids	Qualitative interview	Evaluate collaborative care treatment with buprenorphine	• Intervention is feasible • High retention rates • Only 6.9% had aberrant urine opioid screen at delivery
Hand et al., 2017 28	Access	Pregnant women	SUD treatment, (n=8,656)	Criminal justice system	Alcohol or other drugs	Repeated cross-sectional	Characterize pregnant women entering treatment by geographical regions	• Women living in South are more likely to use benzos compared to those in other regions; less likely to use MOUD; less likely to use heroin and be injection drug users
Washio et al., 2018 15	Access	Pregnant women	SUD treatment, (n=166,863)	Criminal justice system	Alcohol	Repeated cross-sectional	Characterize pregnant women who reported alcohol use entering treatment	• Pregnant women who use alcohol were more likely to be referred by the criminal justice system • Marijuana was the most popular co-used substance among pregnant women
Saia et al., 2017 6	Access	Pregnant women	Obstetric clinic, (n=310)	Health care provider	Opioids	Cross-sectional	Describe prenatal care and neonatal outcomes after the implementation of buprenorphine treatment at the clinic	• Increase in the volume of pregnant women treated and children with neonatal abstinence syndrome over time
Brogly et al., 2018 35	Access	Pregnant women	SUD treatment, (n=113)	N/A	Opioids	Cross-sectional	Characterize pregnant women with OUD entering treatment	• Over half had been incarcerated in the past, 30% currently involved in legal proceedings, 15% have unstable housing
Short et al., 2018 25	Access; Referral	Pregnant women	SUD treatment, (n= 88,241)	Criminal justice system, self-referral	Opioids	Repeated cross-sectional	Analyze trends and disparities in receipt of MAT	• MOUD utilization is less likely among the employed, those in intensive outpatient or residential programs, referred from criminal justice or have co-occurring mental health illnesses
Falleta et al., 2018 16	Access; Referral	Pregnant women	SUD treatment, (n= 16)	CPS	Opioids	Qualitative interview	Understand currently or recently pregnant women’s perceptions of CPS in treatment	• Both positive and negative feelings toward CPS exist • CPS is client-focused and provides support but needs are not met and resources are not provided • Patient and caseworker relationship is important
Ondersma et al., 2018 7	Effectiveness	Pregnant women and mothers	Delivery unit, (n=500)	Health care provider	Prescrip-tion opioids, marijuana	Randomized controlled trial	Evaluate the efficacy of the computer-delivered brief intervention	• No evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening
Martino et al., 2018 8	Effectiveness; Referral	Pregnant women and mothers	Reproductive health clinic, (n=439)	Health care provider	Alcohol or other drugs	Randomized controlled trial	Evaluate the efficacy of electronic or clinician based screening and brief interventions for referral to treatment	• Both e-SBIRT and SBIRT significantly reduced days of primary substance use over the follow-up period compared to usual care • No interaction with pregnancy
O’Connor et al., 2018 11	Retention	Pregnant women	Primary care, (n=190)	Health care provider	Alcohol or other drugs	Retro-spective Cohort	Characterize pregnant women’s treatment retention	• MOUD utilization before conception would likely improve treatment outcomes
Cochran et al., 2018 32	Effectiveness	Pregnant women	SUD treatment, (n=21)	Health care provider	Opioids	Prospective cohort	Optimize and evaluate patient navigation intervention	• Significantly improved illicit opioid use abstinence and decreased in drug use and depression
Clemans et al., 2019 33	Access	Pregnant women	Health care setting, (n=72,086)	Health care provider	Opioids	Retro-spective cohort	Analyze maternal and infant care, Medicaid costs, and outcomes related to maternal OUD	• 75% of women with OUD had at least some treatment related to substance use but treatment was not continuous • Health care costs were higher for women with OUD than those with other substance use disorders
Frazer et al., 2019 30	Access	Pregnant women	SUD treatment, (n=20)	Friend/partner, Health care provider, Criminal justice system	Alcohol or other drugs	Qualitative interview	Identify motivators and barriers to treatment	• Motivators: readiness to stop using, concern for the baby’s health, concern about custody of the baby or other children, wanting to escape violent environments or homelessness, and seeking structure • Barriers: fear of loss of custody, not wanting to be away from children/partner, concern about stigma or privacy, and lack of childcare and transportation
Shenai et al., 2019 9	Effectiveness	Pregnant women	Antepartum unit, (n=31)	Health care provider	Alcohol or other drugs	Prospective cohort	Evaluate the efficacy of a brief education session	• All women reported multiple lifetime traumatic experiences • Session improved their knowledge about diagnoses • Increased likelihood of pursuing further dual treatment