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

项目总结 在过去的15年中，怀孕期间阿片类药物使用障碍(OUD)的流行率增加了近500% 好几年了。虽然怀孕期间接受OUD治疗的动机和依从性提高了，但高达80%的 患有OUD的产后患者在分娩后六个月内再次使用非法阿片类药物。不断增长的 有证据表明，在普通人群中，积极的社会联系和强大的社会纽带 与改善的OUD康复结果相关(例如，减少渴望，降低复发风险)。相反， 孤独和社会孤立是阿片类药物滥用和复发的重要预测因素，特别是对女性来说。 在从怀孕到产后的过渡期，孤独感增加，表明孤独感增加 出现不利复苏结果的风险。此外，第四个三个月期间的复发风险(即从分娩开始的时间 至产后12周)可能由独特的产后应激源造成，包括产后抑郁 焦虑，睡眠障碍，对疼痛管理的强烈需求，以及照顾特定的压力。我们的 总体目标是了解社会联系在与恢复相关的结果中的作用，特别是 在产后第四个月，一个理想的拐点，具有未开发的潜力。为了实现这一目标，我们 将追求三个目标。前两个目标将利用现有数据(源自DP2-HD105541；PI：Allen)，来自 50名有OUD的参与者和25名对照参与者在怀孕期间进行了5个月的随访 产后。使用生态瞬时评估(EMA)与医疗记录数据配对，我们将评估 社会连通性和与社会发展相关的恢复结果。我们将评估不同的理论模型 通过测试社会联系的主要和压力缓冲效应在这一人群中的社会联系 关于产后一年内的康复结果(目标1)。此外，我们还将描述 妊娠晚期的社会联系以及模式/变化与母亲康复的关系 成果(目标2)。最后，我们将完成与来自目标的30名参与者的关键线人访谈 探讨干预的可行性、可接受性和机会，以提高社会地位 连通性，以改进治疗和预防产后复发(目标3)。这样做的结果 无论结果如何，研究都将直接促进有关社会联系作用的科学知识 在产后恢复中。此外，这项工作将能够确定新的干预目标， 这将有助于开发针对第四种疾病量身定做的新的、高影响的复发预防疗法 三个月，一个独特的转折点，有大量未开发的机会。这将直接影响到8万人- 每年有12万名妇女、婴儿和家庭遭受围产期流产的后果。

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.