Community-based fetal ultrasound and care navigation: An approach to engaging pregnant women with substance use disorder in prenatal care and substance use treatment

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Project Summary Background: Pregnant women with substance use disorders (SUDs) experience significant barriers to prenatal care and SUD treatment, magnified for NIH-designated populations with health disparities (HDPs; e.g., minoritized, low-income, rural). Often underserved and under-studied, women with SUDs and their children have inequitable health outcomes compared to non-substance using women and compared to those from non-HDPs. Although effective, evidence-based treatments for SUDs exist, they currently reach only 10-40% of pregnant women with SUDs across the nation, with multi-level structural and systemic barriers for marginalized populations. To adequately address the complex issues leading to health disparities among pregnant women and children impacted by SUDs, we must be successful at engaging women by removing barriers, empowering care choices, and ensuring equitable treatment availability and delivery. This preliminary study brings together interprofessional expertise, novel tools, and innovative care delivery approaches to explore a potentially low-cost translatable approach with potential to transform the state of health equity among individuals at high risk for maternal morbidity and mortality (MMM). Fetal ultrasound imaging has emerged as a potential tool in the promotion of mental-fetal connection, linked to enhanced engagement in prenatal care and SUD treatment. Study Design: To address MMM in HDP pregnant women with SUDs we will test a multi- component intervention involving individual components previously tested by our team: a novel ultrasound-based protocol implemented in the community, developed through 20 years of fetal neurobehavioral research (NEXUS: Neurobehavior, Engagement, ConneXion through UltraSound), integrated with patient navigation and care coordination. This sequential explanatory mixed-methods study will test the feasibility and acceptability (Aim 1) and preliminary effects (Aim 2) of the multi-pronged NEXUS intervention, versus a comparator, in n=60 pregnant individuals with SUDs. We will explore factors related to implementation (Aim 3) to contribute key data for future larger-scale trials and translational work to evaluate this approach as a potentially low-cost, accessible, sustainable method for engaging women with prenatal care and SUD treatment. Even if the intervention is not successful, our research aims will provide ample data to determine best practices and alternative strategies. Impact: Health care is necessarily moving back into the community so the high risk of this project is a calculated one, with methods that can be scaled and modified for sustainability. This study is built upon proven community engagement strategies from this team’s previous work and attempts to address contributing factors related to social determinants of health affecting this highly marginalized population of pregnant women experiencing SUDs. We have developed partnerships with key community and state stakeholders to jointly evaluate the strategies, outcomes, and plans for sustainability. All of the techniques planned for this program are easily translatable to populations of pregnant persons with other risk factors including mental health conditions.