Evaluating Social Connectedness to Support Recovery from Opioid Use Disorder during the Postpartum Period

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PROJECT SUMMARY The prevalence of opioid use disorder (OUD) during pregnancy has increased by nearly 500% over the past 15 years. While motivation for and compliance with OUD treatment during pregnancy is heightened, up to 80% of postpartum individuals with OUD relapse to illicit opioid use within six months of childbirth. A growing body of evidence indicates that, in the general population, positive social connectedness and strong social bonds are associated with improved OUD recovery outcomes (e.g., reduced craving, lower risk of relapse). Conversely, loneliness and social isolation are significant predictors of opioid misuse and relapse, particularly for women. Loneliness increases during transitional periods including from pregnancy to postpartum, signaling increased risk for adverse recovery outcomes. Moreover, relapse risk during the fourth trimester (i.e., the time from delivery to postpartum week 12) may be compounded by unique postpartum stressors, including postpartum depression and anxiety, sleep disturbances, heightened need for pain management, and caregiving-specific stress. Our overall goal is to understand the role of social connectedness in OUD-related recovery outcomes, specifically during the postpartum fourth trimester, an ideal inflection point with untapped potential. To achieve this goal we will pursue three aims. The first two aims will utilize existing data (derived from DP2-HD105541; PI: Allen) from 50 participants with OUD and 25 control participants who were followed from pregnancy through five months postpartum. Using ecological momentary assessments (EMA) paired with medical record data, we will assess social connectedness and OUD-related recovery outcomes. We will evaluate differing theoretical models of social connectedness in this population by testing the main and stress-buffering effects of social connectedness on recovery outcomes up to one year postpartum (Aim 1). Additionally, we will characterize dynamic changes in social connectedness across the fourth trimester and how patterns/changes relate to mothers’ recovery outcomes (Aim 2). Lastly, we will complete key informant interviews with 30 participants from the target population to explore the feasibility, acceptability, and opportunities for intervention to enhance social connectedness to improve the treatment of OUD and prevent postpartum relapse (Aim 3). The results of this study, regardless of outcome, will directly contribute to scientific knowledge on the role of social connectedness in postpartum OUD recovery. Moreover, this work will allow for the identification of new intervention targets, which will contribute to the development of novel, high-impact relapse prevention treatments tailored to the fourth trimester, a unique inflection point with ample untapped opportunity. This will be directly impactful to the 80,000- 120,000 women, infants, and families suffer the consequences of perinatal OUD every year.