Pregnant and Postpartum Women and Behavioral Health Integration

Definition

Perinatal behavioral health conditions include mental health and substance use disorders (SUD) during pregnancy and the postpartum period (up to 12 months after delivery).

Prevalence

Perinatal mental health disorders are a common and significant complication of pregnancy and the postpartum period. An estimated 10-20 percent of women in the United States experience perinatal depression.1 Perinatal anxiety is estimated to affect 8-20 percent of women.2, 3 Other common perinatal mental health disorders include obsessive compulsive disorder, panic disorder, and post-traumatic stress disorder.4 Comorbid perinatal depression and anxiety disorders are common among pregnant and postpartum women.5, 6, 7 Postpartum psychosis, a rare and severe psychiatric emergency, is estimated to occur in 1 to 2 of every 1,000 births.4

The risk of developing SUD is highest for women ages 18 to 29 years old and increases throughout the reproductive years.8 Tobacco/nicotine is the most commonly used substance during pregnancy, followed by alcohol, marijuana/cannabis, opioids and other illicit substances. In 2019, 9.6% of pregnant women aged 15 to 44 years old in the United States reported using tobacco products in the past month, 9.5% reported using alcohol, 5.4% reported using marijuana, and 0.4% reported using opioids.9 Co-occurring SUDs are common among pregnant and postpartum women.10

Severe Impact of Untreated Perinatal Behavioral Health Conditions

Left untreated, perinatal depression, anxiety, and SUD worsen maternal mortality rates (including suicide and overdose), and are associated with severe maternal morbidity.11, 12, 13, 14, 15, 16 Between 2008 and 2017, almost 10 percent of pregnancy-related deaths were due to suicide, overdose/poisoning, and mental health-related unintentional injuries.17

Untreated perinatal depression and anxiety can lead to reduced engagement in perinatal care; increased substance use; and an increased risk of poor mother–infant attachment, stillbirth, premature birth, low birth weight, delayed cognitive and emotional development for infants, and behavioral problems in later life.4, 18, 19, 20, 21 Having an untreated mental health disorder is a major risk factor for SUD and suicide in the postpartum period.22

Substance use during pregnancy, including the use of tobacco/nicotine, alcohol, marijuana/cannabis, opioids, stimulants, or other illicit drugs, is associated with increased risk of stillbirth, premature birth, low birth weight, and birth defects.23 Use of alcohol and drugs during pregnancy can also cause neonatal abstinence syndrome (NAS), which can cause a constellation of symptoms in the infant including tremors, irritability, poor sleep and poor feeding.24

Need for Behavioral Health Integration

Pregnant and postpartum women who have a behavioral health condition are less likely to be receiving adequate care compared to women who are not pregnant.25, 26 OB/GYNs, family physicians, pediatricians, advanced practice nurses, nurses, midwives, doulas, and other primary care providers play a critical role in identifying pregnant and postpartum women with untreated behavioral health conditions and connecting them with care.

Implementing integrated behavioral health in all practice settings allows pregnant and postpartum women to address behavioral health issues in a place where they already have relationships and feel comfortable. Integrated behavioral health care improves the reliability of screening, increases the efficiency of referrals, reduces barriers to treatment for mental health and substance use disorders, and improves health outcomes for pregnant and postpartum women.27, 28, 29, 30, 31, 32

Integrating Perinatal Behavioral Health Services—How To

Key Components

Integrated health programs and systems ensure that there is no wrong door – that access to care is available at any point of entry – for pregnant and postpartum women who need behavioral health treatment. Facilitating and implementing key components of integrated behavioral healthcare can improve health outcomes for pregnant and postpartum women. 33, 34

  • Protocols for screening, brief intervention, referral to treatment (SBIRT) for SUD and mental health disorders. Establish protocols to identify pregnant and postpartum women who could benefit from behavioral health services and ensure appropriate referrals and follow up to behavioral health services (e.g., group and individual SUD treatment, individual and group counseling, psychiatric care, pediatric care, hepatitis C treatment) after a positive screening.
  • Patient-provider communication. For pregnant and postpartum women to receive the greatest benefit from integrated care, they must actively communicate symptoms to their providers, remain engaged throughout their care, and ask questions about their care. This requires an established foundation of trust and compassion. It is important to educate pregnant and postpartum women and their partners about integrated care and encourage them to actively participate in their care and care planning . It is even more important to do so with language that shows compassion and care and avoids stigmatization, dehumanization, and harm .
  • Shared care plans. Electronic health records (EHRs) can be a useful communication tool if they are integrated, but are often insufficient in ensuring adequate care team collaboration. Developing a shared care plan can ease the exchange of clinical information, medication reconciliation, and other forms of coordination that engage patients as full participants in their care and allow care team members to gauge patient stability and indicate any changes in treatment.
  • Telehealth expansion . The use of telehealth technologies has helped address care disruptions and improve access for pregnant and postpartum women during the COVID-19 pandemic, especially in rural areas and areas with provider shortages. 35 Telehealth technology can be used during pregnancy and the postpartum period to provide mental health and substance use disorder screening and treatment, facilitate patient-provider communication so that women can conveniently raise issues or concerns with care team members, and remotely monitor key vital signs.
  • Expanded care team members and roles . Tailor care team roles and obtain the behavioral health expertise needed to meet the needs of pregnant and postpartum women with behavioral health conditions. Practices may be able to obtain training and support for nurses, midwives, and other obstetrics and primary care providers and practitioners to prescribe the medications for opioid use disorder (MOUD) while providing care. Practices can also incorporate psychologists, psychiatrists, social workers, substance use counselors, peer recovery support specialists, recovery coaches, and/or community health workers into care teams to meet the needs of patients.
  • Care coordination. Establish operational systems to support quick coordination and triage to respond immediately to the needs of pregnant and postpartum women with behavioral health conditions. Practices can add patient navigators and nurse care managers to care teams to assist pregnant and postpartum women with accessing care.
  • Collaborative and co-located care. There may be opportunities for practices to collaborate with other healthcare settings (e.g., an emergency department that offers MOUD initiation) to ensure 24/7 rapid access to treatment or to locate OBGYN, primary care and behavioral health care team members in the same space or in different departments/locations within the same facility. Collaborative and co-located care can be particularly useful when caring for high-risk patients who may present to care infrequently, as it allows providers to triage and treat the most urgent issues.
  • Community partnerships. Determine what behavioral health supports and services are feasible to offer in-practice and connect pregnant and postpartum women with external behavioral health providers, specialty care providers, and other community resources (e.g., methadone clinics, residential addiction treatment centers, health departments, recovery supports, intimate partner violence shelters and programs, emergency food providers, income support programs, housing support services, employment assistance, transportation, and family planning) as needed, to complement services available within the practice setting. A patient navigator or community health worker can help facilitate these linkages to care.

Models

The perinatal period is a critical time to address mental health and substance use disorders for women. There are several models of integrated care that can connect pregnant and postpartum women with the behavioral health services they need.

Programs

The following table includes a sample of integrated perinatal behavioral health programs that have blended and adapted aspects of various integrated care models.

  MaineMOM Moms in Recovery Program Project RESPECT UNC Horizons Program Drug Free Moms and Babies Maternal Mental Health NOW MCPAP for Moms
SBIRT - Screening and brief intervention X X X X X X X
SBIRT - Referral to treatment X X X X X X X
Patient- provider communication X X X X X X  
Expanded care team members and roles X X X X X X X
Shared care plans X X X X X Not Applicable Not Applicable
Care coordination X X X X X X Not Applicable
Collaborative and co-located care X X X X Not Applicable X Not Applicable
Telehealth X X X X Not Applicable Not Applicable X
Community partnerships X X X X X Not Applicable X

What Should I Consider When Providing Integrated Behavioral Health in the Perinatal Period?

Pregnant and postpartum women with behavioral health conditions will vary widely in the types and intensity of the supports they need for treatment and recovery, and those needs may change over the course of pregnancy and after childbirth. There also are key aspects of perinatal behavioral health conditions that practices should consider when providing care, some related to patient needs and others regulatory in nature.

Stigma and Fear

Stigma and fear may keep pregnant and postpartum patients from seeking, initiating, and continuing to access substance use and mental health treatment services. Pregnant and postpartum women that are using substances fear referral to child welfare agencies, loss of parental rights, and incarceration.36, 37, 38, 39 Some common provider behaviors, use of language, attitudes, and beliefs can create stigmatizing interactions with pregnant and postpartum women and contribute to these fears.40, 41

Addressing fear and stigma is key in connecting pregnant and postpartum women with behavioral health conditions with treatment services. Discuss fears and concerns openly and compassionately and as early as possible. Speak transparently and not coercively about what impacts drug toxicology results may have on child welfare agency involvement. For example, advise patients that integrated perinatal behavioral health care is associated with maintaining legal custody of children at birth.42

Resources

Mandatory Reporting for Substance Use During Pregnancy

Many states have reporting mandates related to the disclosure of substance use and/or engagement in substance use treatment by pregnant women. Informed consent should be obtained prior to screening, testing, and treatment of pregnant patients for substance use disorder.43, 44 Informed consent includes a non-coercive and supportive discussion with the patient about the benefits and potential implications of mandatory state reporting laws (e.g., loss of parental rights, custody, or incarceration).

Resources

Policy Listings:

Example Algorithms and Workflows:

Universal Screening for Mental Health and Substance Use Disorders

Using empirically validated approaches and tools for universal screening is essential for integrated perinatal behavioral healthcare. Screening for mental health and substance use disorders at least once during the perinatal period – at the first prenatal visit for substance use and SUD and at the postpartum checkup for mental health disorders – using a validated instrument has been recommended for all pregnant and postpartum women to identify those women that need to be connected with perinatal behavioral health treatment and appropriate follow-up.45, 46, 47, 48, 49, 50, 51, 52, 53, 54

Resources

Example Algorithms and Workflows:

Mental Health Screening Tools:

  • PHQ–9 (Patient Health Questionnaire 9) for depression [PDF - 39.9 KB]
  • EPDS (Edinburgh Postnatal Depression Scale) [PDF - 137 KB]
  • PASS (Perinatal Anxiety Screening Scale)
  • GAD-7 (Generalized Anxiety Disorder 7)
  • MDQ (Mood Disorder Questionnaire) for bipolar disorder

Substance Use Screening Tools:

  • 4 Ps (Parents, Partner, Past and Pregnancy) [PDF - 10.2 KB]
  • T-ACE (Tolerance, Annoyed, Cut Down, Eye-opener) for alcohol use during pregnancy
  • TAPS (Tobacco, Alcohol, Prescription Medication, and Other Substance Use)
  • CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) for adolescent substance abuse

Universal Screening for Social Determinants of Health

In addition to universal screening of pregnant and postpartum women for mental health and substance use disorders, it is imperative to identify women at increased risk for other perinatal behavioral health conditions. Women experiencing intimate partner violence (IPV) are at increased risk of substance use. IPV often begins or escalates during pregnancy and the postpartum period, and is also associated with an increased risk of adverse maternal and neonatal outcomes.55, 56, 57, 58 Additionally, history of adverse childhood experiences (ACEs) increases risk of perinatal anxiety and/or depression.59, 60 Other social determinants of health (SDOH) risk factors, including disparate access to care, transportation barriers, food and housing insecurity, and lack of social support also increase susceptibility to perinatal behavioral health conditions.61, 62, 63

Universal screening for IPV, ACEs, and other SDOH risk factors is essential for identifying pregnant and postpartum women at increased risk for perinatal behavioral health conditions and providing care that is trauma-informed.64 Like screening for mental health and substance use disorders, it is critical that these screenings are completed periodically – commonly recommended at annual exams, initial prenatal visits, and postpartum checkups – with validated tools in a setting that is conducive to potentially difficult conversations and one that ensures privacy and confidentiality.65, 66, 67, 68, 69

Resources

Example Algorithms and Workflows:

IPV Screening Tools:

  • HITS (Hurt, Insult, Threaten, Scream) [PDF - 1,752 KB]
  • OVAT (Ongoing Violence Assessment Tool) [PDF - 1,752 KB]
  • STaT (Slapped, Things and Threaten) [PDF - 1,752 KB]
  • WAST (Woman Abuse Screen Tool) [PDF - 1,752 KB]
  • HARK (Humiliation, Afraid, Rape, Kick)
  • AAS (Abuse Assessment Screen)
  • PVS (Partner Violence Screen)
  • SAFE-T (Secure, Acceptance, Family, Even, Talk Measure)
  • PSQ (Parent Screening Questionnaire)
  • OAS (Ongoing Abuse Screen)

ACEs Screening Tools:

  • ACE Questionnaire [PDF - 268 KB]
  • CTQ–SF (Modified Childhood Trauma Questionnaire–Short Form)
  • PEARLS (The Pediatric ACEs and Related Life Events Screener) [PDF - 266 KB]

SDOH Screening Tools:

  • SEEK PQ-R (A Safe Environment for Every Kid Parent Questionnaire-R) [PDF - 105 KB]
  • WE CARE (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education) Survey
  • PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences)
  • ACH HRSN (Accountable Health Communities Health-Related Social Needs) Screening Tool [PDF - 328 KB]
  • The EveryONE Project Social Needs Screening Tool [PDF - 764 KB]
  • IHELP (Income, Insurance, Hunger, Housing, Homeless, Education, Safety, Legal Status, Power of Attorney) Pediatric Social History Tool

Universal Screening for Infectious Diseases

Sexually transmitted diseases (STIs) are common among pregnant women, and those with SUD are at increased risk for contracting STIs and hepatitis C.70, 71, 72 If left untreated, these infectious diseases can be transmitted to the fetus and lead to adverse pregnancy outcomes and development outcomes in the child.7374 Universal testing for HIV, hepatitis B, hepatitis C, gonorrhea, chlamydia, and syphilis has been recommended for all pregnant women.75, 76, 77, 78

Resources

Polysubstance Use

Polysubstance use (using more than one substance at a time) during pregnancy is common, is highest during early pregnancy, and is often associated with comorbid perinatal depression and other psychiatric conditions.79, 80, 81, 82, 83, 10 Pregnant and postpartum women who use multiple substances are at the greatest risk for depression and anxiety.83 Identifying and understanding how pregnant and postpartum women are using substances is key for treatment planning.

Resources

Co-occurring Mental and Substance Use Disorders

Co-occurring mental and substance use disorders affected 4.6 million women aged 18 or older in the United States in 2019.84 From 2005-2014, pregnant women with perinatal depression and anxiety were more likely to have at least one SUD, compared to other pregnant women hospitalized for delivery.85 It is often difficult to distinguish between the two conditions as exacerbations in mental health disorders may contribute to relapses/return to substance use in pregnant or postpartum women. Similarly, symptoms associated with ongoing substance use or withdrawal may mimic common mental health disorders, such as irritability, agitation, and insomnia. Careful attention to both conditions is essential in providing optimal and patient-centered care.

Resources

Initiation or Continuation of Medications

Decisions around the initiation and continuation of medications for perinatal mental health and substance use disorders should be based on assessment, diagnoses, patient needs, and patient consent. It is not uncommon for providers or patients to abruptly discontinue medications for mental health and substance use disorders after discovering pregnancy, causing an exacerbation of symptoms and relapse of an SUD.86, 45, 87, 88 Several professional organizations and regulatory bodies advise against abruptly stopping medications, and treatment with buprenorphine or methadone throughout the pregnancy is considered the standard of care.44, 45, 89, 90 Stabilizing with medication can be less risky and do less harm (see the “What Works” section below) than leaving perinatal behavioral health conditions sub-optimally treated.

Perinatal, primary care, behavioral health providers, and other subspecialty providers on the care team can coordinate and collaborate to determine maternal and fetal risks and benefits, discuss those benefits and risks with pregnant and postpartum women, and engage in shared decision-making to determine the best treatment plan.

Resources

Treating Perinatal Behavioral Health Conditions—What Works?

A mix of pharmacological and nonpharmacological interventions may be used for treating pregnant and postpartum women with mental health and substance use disorders. Primary care providers will need to coordinate and collaborate with perinatal, primary care, behavioral health providers, and other subspecialty providers on the care team to determine maternal and fetal risks and benefits, create an individualized, patient-centered treatment plan, make clinical decisions, and manage care for pregnant and postpartum patients across various care settings.

Depression and Anxiety

Pregnant and postpartum women with perinatal depression may experience feelings of extreme sadness, anxiety, loss of interest in usual activities, and fatigue that may make it difficult for them to function and care for themselves or others.91 Pregnant and postpartum women with perinatal anxiety may experience feelings of excessive worry, fear, tension, and doom; restless sleep, panic attacks, hyperventilation, and other physical symptoms of worry; and obtrusive, obsessive, and repeated thoughts or images of scary things happening to the baby that may start to interfere with daily functioning, relationships, or job performance.4, 92 Untreated perinatal depression or anxiety may increase the risk of preterm birth and is associated with low birth weight, small for gestational age, stillbirth, and maternal morbidity.4, 18, 19, 93

For mild to moderate perinatal depression or anxiety, nonpharmacologic therapy is the first-line treatment. Cognitive behavioral therapy (CBT), mental health counseling, mindfulness, yoga, relaxation interventions, supportive and educational based interventions (e.g., sleep hygiene), acupressure, acupuncture, and diet and exercise are common nonpharmacological interventions that are effective for pregnant and postpartum women with perinatal depression and anxiety.94, 95, 96, 97

For moderate to severe perinatal depression or anxiety, pharmacotherapy in conjunction with nonpharmacologic therapy is the first-line treatment. Practice recommendations for the use of medications for depression or anxiety during pregnancy vary but consistently advise the use of monotherapy (as opposed to combination therapies) at the lowest effective dose, when possible.98, 99 For pregnant and postpartum women with psychosis or complex co-occurring mental health disorders, a combination of medication may be required.

The priority for treatment is stability in the mother's mood throughout pregnancy. Dosage adjustments should be made on a clinical basis. Abruptly stopping pharmacological treatments, such as antidepressants, can lead to relapse of depression and anxiety symptoms.100 Providers should engage in shared decision making with the patient regarding the risks and benefits of medications for maternal mental health disorders during pregnancy.101

Resources

Alcohol Use

There is no known safe amount of alcohol use during pregnancy or while trying to become pregnant. Alcohol use during pregnancy can cause miscarriage, stillbirth, preterm birth, low birth weight, and fetal alcohol spectrum disorders (FASDs), a range of lifelong birth defects and behavioral and intellectual disabilities.102, 103, 104, 105

Practice recommendations for screening for alcohol use during pregnancy include brief intervention to discuss the risks of alcohol use as well as resources available to assist in reducing alcohol use.106, 107 Motivational interviewing counseling sessions and brief interventions consisting of knowledge assessment with feedback, contracting and goal setting, behavioral modification, and a summary are common nonpharmacological interventions that are effective for pregnant women using alcohol.108, 109, 110

Medications for alcohol use disorder (MAUD) have not been proven completely safe during pregnancy or breastfeeding and have not been approved by the U.S. Food and Drug Administration (FDA) for use in adolescents younger than 18 years old. Practice recommendations advise weighing the benefits and risks of using MAUD (naltrexone or acamprosate) for the treatment of alcohol use disorder (AUD) during pregnancy versus risks of ongoing alcohol use.111, 112, 113

Resources

Opioid Use

Opioid use during pregnancy has been linked to maternal mortality, poor fetal growth, preterm birth, stillbirth, and neonatal opioid withdrawal syndrome (NOWS), a withdrawal syndrome caused by in utero exposure to opioids.114, 115, 116

Practice recommendations for screening for opioid use during pregnancy include brief intervention to discuss risks of ongoing opioid use as well as resources available for treatment.44

Practice recommendations advise against opioid detoxification during pregnancy, which is associated with high rates of relapse.117 Opioid agonist pharmacotherapy using medication for opioid use disorders (MOUD) plays an important role in reducing complications and risks, stabilizing maternal craving and withdrawal symptoms, reducing repeated periods of intoxication and withdrawal, and improving neonatal and maternal outcomes.118, 119 Practice recommendations advise using MOUD (methadone, buprenorphine, or buprenorphine/naloxone) in conjunction with counseling and behavioral therapy to treat opioid use disorder (OUD) in pregnant and postpartum women.44,87,118 For opioid agonist pharmacotherapy using buprenorphine, buprenorphine/naloxone therapy is becoming the standard of care for pregnant and postpartum women as it reduces the risks of diversion and misuse associated with monotherapy.120

NOWS is an expected and treatable condition that can follow exposure to MOUD. Maternal dose of MOUD is not related to the severity of NOWS, and reducing medication dose in an attempt to prevent NOWS may destabilize OUD and increase substance use, resulting in greater risk to the fetus.121, 122 Dosage adjustments during pregnancy should be made on a clinical basis. Practice recommendations encourage postpartum women to breastfeed while using MOUD, as it may reduce clinical signs of NOWS, provided no other breastfeeding contraindications exist (e.g., HIV or ongoing substance use).123

Resources

Tobacco and Nicotine Use

Cigarette smoking during pregnancy increases the risk of stillbirth, preterm birth, low birth weight, birth defects of the mouth and lip, and sudden infant death syndrome (SIDS).124, 125, 126, 127 E-cigarettes and tobacco products containing nicotine can cause damage to fetal brain and lung tissue.128, 129

Practice recommendations for screening for tobacco or nicotine use during pregnancy include brief intervention to discuss risks as well as resources available to reduce use.130, 131 Motivational interviewing; individual, group, and telephone counseling; mobile phone-based interventions; and contingency management are common nonpharmacological interventions that are effective for pregnant women using tobacco and nicotine.132, 133, 134

There is insufficient evidence available to assess the balance of benefits and harms of e-cigarettes, nicotine replacement products, and other pharmaceuticals for tobacco cessation during pregnancy, and e-cigarettes are not approved by the FDA to help people quit smoking.131, 135 Shared decision making around the use of pharmaceuticals for tobacco cessation should be made in collaboration with the patient.130

Resources

Marijuana and Cannabis Use

While the health effects of using cannabidiol (CBD) products during pregnancy are currently unknown, there is some evidence that marijuana use during pregnancy may increase risk of stillbirth and may cause low birth weight, preterm birth, abnormal fetal brain development, and long-term brain development issues linked to increased anxiety, aggression, and hyperactivity.136, 137, 138, 139, 140, 141 FDA strongly advises against the use of all forms of CBD, tetrahydrocannabinol (THC), and marijuana during pregnancy or while breastfeeding.142

Practice recommendations for screening for marijuana and cannabis use during pregnancy and lactation include brief intervention to discuss risks and available resources for reducing use.143, 144 Pregnant women may be unaware that ongoing cannabis use is unsafe, particularly in states where medical cannabis has been legalized and where dispensaries recommend its use during pregnancy.145 It can be useful to discuss with a pregnant patient why she is using cannabis (e.g., to self-treat anxiety, insomnia, nausea) so that safer alternative remedies can be discussed.

There are currently no FDA approved pharmacological interventions for marijuana and cannabis use.

Resources

Stimulant Use

Use of methamphetamine or cocaine during pregnancy increases the risk of preterm birth, low birth weight, and smaller head circumference.146, 147

Practice recommendations for screening for methamphetamine or cocaine use during pregnancy include brief intervention to discuss risks and available resources for reducing use.148, 149, 150 Contingency management, community reinforcement approach, CBT, motivational interviewing, are common nonpharmacological interventions that are effective for methamphetamine or cocaine use in women of reproductive age.151, 152, 153, 154, 155, 156

There are currently no FDA approved pharmacological interventions for stimulant use.

Resources

Supporting Integrated Perinatal Behavioral Health Care with Policy Changes and Payment Reform

Several calls to action and recommendations have been issued for policy-related changes to support integrated perinatal behavioral healthcare.33,34, 157, 158, 159, 160, 161 Federal and State policy changes and payment reforms could incentivize integrated perinatal behavioral healthcare by allowing billing and reimbursement of services that are key to the integrated care models.

  • Offering provider incentives to complete perinatal behavioral health screenings
  • Increasing reimbursement for perinatal behavioral health-related services
  • Expanding Medicaid coverage for postpartum women

References

1. Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69:575–581. https://dx.doi.org/10.15585/mmwr.mm6919a2. Accessed August 18, 2022.

2. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate bayesian meta-analysis. J Clin Psychiatry. 2019 Jul 23;80(4):18r12527. https://doi.org/10.4088%2FJCP.18r12527 . Accessed August 18, 2022.

3. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry. 2017 May;210(5):315-323. https://doi.org/10.1192/bjp.bp.116.187179. Accessed August 18, 2022.

4. O'Hara MW, Wisner KL. Perinatal mental illness: Definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014 Jan;28(1):3-12. https://doi.org/10.1016/j.bpobgyn.2013.09.002. Accessed August 18, 2022.

5. Falah-Hassani K, Shiri R, Dennis CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: A meta-analysis. Psychol Med. 2017 Sep;47(12):2041-2053. https://doi.org/10.1017/S0033291717000617. Accessed August 18, 2022.

6. Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, Eng HF, Luther JF, Wisniewski SR, Costantino ML, Confer AL, Moses-Kolko EL, Famy CS, Hanusa BH. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013 May;70(5):490-8. https://doi.org/10.1001/jamapsychiatry.2013.87. Accessed August 18, 2022.

7. Farr SL, Dietz PM, O'Hara MW, Burley K, Ko JY. Postpartum anxiety and comorbid depression in a population-based sample of women. J Womens Health(Larchmt). 2014 Feb;23(2):120-8. https://doi.org/10.1089/jwh.2013.4438 . Accessed August 18, 2022.

8. Prince MK, Ayers D. Substance use in pregnancy. [Updated 2022 Jan 3]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan. Available from https://www.ncbi.nlm.nih.gov/books/NBK542330/. Accessed August 18, 2022.

9. Substance Abuse and Mental Health Services Administration. 2019 National Survey on Drug Use and Health: Women. 2020, Sept. Available from: https://www.samhsa.gov/data/report/2019-nsduh-women . Accessed August 18, 2022.

10. Jarlenski M, Krans EE. Co-occurring substance use disorders identified among delivery hospitalizations in the United States. J Addict Med. 2021 Nov-Dec 01;15(6):504-507. https://doi.org/10.1097/ADM.0000000000000792. Accessed August 18, 2022.

11. Courchesne NS, Smith LR, Zúñiga ML, Chambers CD, Reed MB, Ballas J, Marienfeld CB. Association of alcohol and other substance-related diagnoses with severe maternal morbidity. Alcohol Clin Exp Res. 2021 Sep;45(9):1829-1839. https://doi.org/10.1111/acer.14671. Accessed August 18, 2022.

12. Jarlenski M, Krans EE, Chen Q, Rothenberger SD, Cartus A, Zivin K, Bodnar LM. Substance use disorders and risk of severe maternal morbidity in the United States. Drug Alcohol Depend. 2020 Nov 1;216:108236. https://doi.org/10.1016/j.drugalcdep.2020.108236. Accessed August 18, 2022.

13. Brown CC, Adams CE, George KE, Moore JE. Mental health conditions increase severe maternal morbidity by 50 percent and cost $102 million yearly in the United States. Health Aff. 2021 Oct;40(10):1575-1584. https://doi.org/10.1377/hlthaff.2021.00759. Accessed August 18, 2022.

14. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Fast Stats. https://datatools.ahrq.gov/hcup-fast-stats?count=3&tab=hcupfsse&type=subtab. Accessed August 18, 2022.

15. Chen J, Cox S, Kuklina EV, Ferre C, Barfield W, Li R. Assessment of incidence and factors associated with severe maternal morbidity after delivery discharge among women in the US. JAMA Netw Open. 2021;4(2):e2036148. https://doi.org/10.1001/jamanetworkopen.2020.36148 . Accessed August 18, 2022.

16. Smid MC, Maeda J, Stone NM, Sylvester H, Baksh L, Debbink MP, Varner MW, Metz TD. Standardized criteria for review of perinatal suicides and accidental drug-related deaths. Obstetrics & Gynecology. 2022;136(4):645–653. https://doi.org/10.1097/AOG.0000000000003988. Accessed August 18, 2022.

17. Davis NL, Smoots AN, Goodman DA. Pregnancy-related deaths: Data from 14 U.S. maternal mortality review committees, 2008-2017. Atlanta, GA: Centers for Disease Control and Prevention; 2019. Available from: https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/MMR-Data-Brief_2019-h.pdf (PDF - 664 KB). Accessed August 18, 2022.

18. Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65(7):805–815. https://doi.org/10.1001/archpsyc.65.7.805. Accessed August 18, 2022.

19. Jahan N, Went TR, Sultan W, Sapkota A, Khurshid H, Qureshi IA, Alfonso M. Untreated depression during pregnancy and its effect on pregnancy outcomes: A systematic review. Cureus. 2021 Aug 17;13(8):e17251. https://doi.org/10.7759/cureus.17251. Accessed August 18, 2022.

20. Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, Dennis CL, Steiner M, Brown C, Cheung A, Dawson H, Rector NA, Guenette M, Richter M. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis. J Clin Psychiatry. 2018 Sep;79(5):17r12011. https://doi.org/10.4088/JCP.17r12011. Accessed August 18, 2022.

21. Muzik M, Borovska S. Perinatal depression: Implications for child mental health. Ment Health Fam Med. 2010 Dec;7(4):239-47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083253/. Accessed August 18, 2022.

22. Mangla K, Hoffman MC, Trumpff C, Grady SO, Monk C. Maternal self-harm deaths: An unrecognized and preventable outcome. Am J Obstet Gynecol 2019;221:295–303. https://doi.org/10.1016/j.ajog.2019.02.056. Accessed August 18, 2022.

23. National Institute on Drug Abuse. Substance use while pregnant and breastfeeding. https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding . Accessed August 18, 2022.

24. Maguire DJ, Taylor S, Armstrong K, Shaffer-Hudkins E, Germain AM, Brooks SS, Cline GJ, Clark L. Long-term outcomes of infants with neonatal abstinence syndrome. Neonatal Netw. 2016;35(5):277-86. https://doi.org/10.1891/0730-0832.35.5.277. Accessed August 18, 2022.

25. Sanmartin MX, Ali MM, Chen J, Dwyer DS. Mental health treatment and unmet mental health care need among pregnant women with major depressive episode in the United States. Psychiatr Serv. 2019 Jun 1;70(6):503-506. https://doi.org/10.1176/appi.ps.201800433. Accessed August 18, 2022.

26. Martin CE, Scialli A, Terplan M. Unmet substance use disorder treatment need among reproductive age women. Drug Alcohol Depend, 2020 Jan;206:107679. https://doi.org/10.1016/j.drugalcdep.2019.107679. Accessed August 18, 2022.

27. Miller ES, Grobman WA, Ciolino JD, Zumpf K, Sakowicz A, Gollan J, Wisner KL. Increased depression screening and treatment recommendations after implementation of a perinatal collaborative care program. Psychiatric Services. 2021 Nov 1;72(11):1268-75. https://doi.org/10.1176/appi.ps.202000563. Accessed August 18, 2022.

28. Byatt N, Levin LL, Ziedonis D, Moore Simas TA, Allison J. Enhancing participation in depression care in outpatient perinatal care settings: A systematic review. Obstet Gynecol. 2015 Nov;126(5):1048-1058. https://doi.org/10.1097/AOG.0000000000001067. Accessed August 18, 2022.

29. Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, Savitz L, James B. Association of integrated team-based care with health care quality, utilization, and cost. JAMA. 2016 Aug 23;316(8):826-34. https://doi.org/10.1001/jama.2016.11232. Accessed August 18, 2022.

30. Cohen D, Davis M, Hall J, Gilchrist E, Miller B. A guidebook of professional practices for behavioral health and primary care integration observations from exemplary sites. AHRQ Publication No. 14-0070-1-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015 Mar. Available from: https://integrationacademy.ahrq.gov/sites/default/files/2020-06/AHRQ_AcademyGuidebook.pdf [PDF - 1,279 KB]. Accessed August 18, 2022.

31. Gerrity M, Zoller E, Pinson N, Pettinari C, King V. Integrating primary care into behavioral health settings: What works for individuals with serious mental illness. New York, NY: Milbank Memorial Fund; 2014. Available from: https://www.milbank.org/wp-content/uploads/2016/04/Integrating-Primary-Care-Report.pdf [PDF - 602 KB]. Accessed August 18, 2022.

32. Gold S, Green L, Peek CJ. From our practices to yours: Key messages for the journey to integrated behavioral health. J Am Board Fam Med. 2017 Jan 2;30(1):25-34. https://doi.org/10.3122/jabfm.2017.01.160100. Accessed August 18, 2022.

33. Seibert J, Dobbins E, Theis E, Murray M, Stockdale H, Feinberg R, Hinde J, Karon SL. Integrating SUD and OB/GYN Care: Policy challenges and opportunities. Washington, DC: Assistant Secretary for Planning and Evaluation; 2022. Available from: https://www.aspe.hhs.gov/sites/default/files/documents/6a0c443b8fe5b6f324771a128bfa2cdc/integrating-sud-obgyn-care.pdf [PDF - 584 KB]. Accessed August 18, 2022.

34. Platt T, Hanlon C. State maternal mortality review committees address substance use disorder and mental health to improve maternal health. Washington, DC: National Academy for State Health Policy; 2021 Aug. Available from: https://www.nashp.org/wp-content/uploads/2021/08/maternal-mortality-review-committees-address-substance-use-disorder-and-mental-health.pdf [PDF - 522 KB]. Accessed August 18, 2022.

35. Brislane Á, Larkin F, Jones H, Davenport MH. Access to and quality of healthcare for pregnant and postpartum women during the covid-19 pandemic. Front Glob Women's Health. 2021 Feb 10;2:628625. https://doi.org/10.3389/fgwh.2021.628625. Accessed August 18, 2022.

36. Weber A, Miskle B, Lynch A, Arndt S, Acion L. Substance use in pregnancy: Identifying stigma and improving care. Subst Abuse Rehabil. 2021 Nov 23;12:105-121. https://doi.org/10.2147/SAR.S319180. Accessed August 18, 2022.

37. Stone, R. Pregnant women and substance use: Fear, stigma, and barriers to care. Health Justice. 2015;3(2). https://doi.org/10.1186/s40352-015-0015-5. Accessed August 18, 2022.

38. Leiner C, Cody T, Mullins N, Ramage M, M Ostrich BM. “The elephant in the room;” A qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia. BMC Pregnancy Childbirth. 2021; 21(143). https://doi.org/10.1186/s12884-021-03596-w. Accessed August 18, 2022.

39. Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interest. 2014 Oct;15(2):37-70. https://doi.org/10.1177/1529100614531398 . Accessed August 18, 2022.

40. Nichols TR, Welborn A, Gringle MR, Lee A. Social stigma and perinatal substance use services: recognizing the power of the good mother ideal. Contemporary Drug Problems. 2021;48(1):19-37. https://doi.org/10.1177/0091450920969200. Accessed August 18, 2022.

41. Budhwani H, De P. Perceived stigma in health care settings and the physical and mental health of people of color in the United States. Health Equity. 2019 Mar 1;3(1):73-80. https://doi.org/10.1089/heq.2018.0079 . Accessed August 18, 2022.

42. O’Connor AB, O’Brien LM, Staring K, Gurenlian L, Alto W. Infants born to mothers in buprenorphine treatment during pregnancy: Involvement with child protective services. [Unpublished manuscript]. Child Welfare. 2022;99(6). Accessed August 18, 2022.

43. American College of Obstetricians and Gynecologists. Committee opinion no. 633: Alcohol abuse and other substance use disorders. Obstet Gynecol. 2015 Jun;125(6):1529-1537. https://doi.org/10.1097/01.AOG.0000466371.86393.9b. Accessed August 18, 2022.

44. American College of Obstetricians and Gynecologists. Committee opinion no. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017 Aug;130(2):e81–94. https://doi.org/10.1097/aog.0000000000002235. Accessed August 18, 2022.

45. Ecker J, Abuhamad A, Hill W, Bailit J, Bateman BT, Berghella V, Blake-Lamb T, Guille C, Landau R, Minkoff H, Prabhu M, Rosenthal E, Terplan M, Wright TE, Yonkers KA. Substance use disorders in pregnancy: Clinical, ethical, and research imperatives of the opioid epidemic: A report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol. 2019 Jul;221(1):B5-B28. https://doi.org/10.1016/j.ajog.2019.03.022. Accessed August 18, 2022.

46. Rafferty J, Mattson G, Earls MF, Yogman MW, Committee on Psychosocial Aspects of Child and Family Health, Gambon TB, Lavin A, Sagin Wissow L. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics. 2019 Jan;143(1):e20183260. https://doi.org/10.1542/peds.2018-3260 . Accessed August 18, 2022.

47. ACOG committee opinion no. 757: Screening for Perinatal Depression. Obstet Gynecol. 2018 Nov;132(5):e208-e212. https://doi.org/10.1097/aog.0000000000002927. Accessed August 18, 2022.

48. Byatt N, Carter D, Deligiannidis, KM, Neill Epperson C, Meltzer-Brody S, Payne JL, Robinson G, Silver NE, Stowe Z, Sayres Van Niel M, Wisner KL, Yonkers KA. Position statement on screening and treatment of mood and anxiety disorders during pregnancy and postpartum. Washington, DC: American Psychiatric Association; 2018. Available from https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Screening-and-Treatment-Mood-Anxiety-Disorders-During-Pregnancy-Postpartum.pdf [PDF - 152 KB]. Accessed August 18, 2022.

49. Association of Women’s Health Obstetric Neonatal Nurses. Mood and anxiety disorders in pregnant and postpartum women. J Obstet Gynecol Neonatal Nurs. 2015, Sep;44(5):687-689. https://doi.org/10.1111/1552-6909.12734. Accessed August 18, 2022.

50. Siu AL, US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016 Jan 26;315(4):380-7. https://doi.org/10.1001/jama.2015.18392. Accessed August 18, 2022.

51. Association of Maternal & Child Health Programs, National Association of State Alcohol and Drug Abuse Directors. SBIRT for pregnant and postpartum women: Opportunities for State MCH programs. Washington, DC: Association of Maternal & Child Health Programs; 2022 Jun. Available from: https://nasadad.org/wp-content/uploads/2020/06/AMCHP-NASADAD-SBIRT-Issue-Brief.pdf [PDF - 875 KB]. Accessed August 18, 2022.

52. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018 Nov 13;320(18):1899-1909. https://doi.org/10.1001/jama.2018.16789. Accessed August 18, 2022.

53. US Preventive Services Task Force, Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Curry SJ, Donahue K, Doubeni CA, Epling JW Jr, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. JAMA. 2020 Jun 9;323(22):2301-2309. https://doi.org/10.1001/jama.2020.8020. Accessed August 18, 2022.

54. World Health Organization. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization; 2014. Available from: http://www.ncbi.nlm.nih.gov/books/nbk200701/. Accessed August 18, 2022.

55. Cheng D, Horon IL. Intimate-partner homicide among pregnant and postpartum women. Obstet Gynecol. 2010 Jun;115(6):1181-1186. https://doi.org/10.1097/aog.0b013e3181de0194. Accessed August 18, 2022.

56. O’Reilly R, Peters K. Opportunistic domestic violence screening for pregnant and post-partum women by community based health care providers. BMC Women’s Health. 2018;18(1):128. https://doi.org/10.1186/s12905-018-0620-2. Accessed August 18, 2022.

57. Alhusen JL, Ray E, Sharps P, Bullock L. Intimate partner violence during pregnancy: Maternal and neonatal outcomes. J Womens Health (Larchmt). 2015;24(1):100-106. https://doi.org/10.1089/jwh.2014.4872. Accessed August 18, 2022.

58. Koch AR, Rosenberg D, Geller SE. Higher risk of homicide among pregnant and postpartum females aged 10-29 years in Illinois, 2002-2011. Obstet Gynecol. 2016;128(3):440-446. https://doi.org/10.1097/aog.0000000000001559. Accessed August 18, 2022.

59. Racine N, Devereaux C, Cooke JE, Eirich R, Zhu J, Madigan S. Adverse childhood experiences and maternal anxiety and depression: A meta-analysis. BMC Psychiatry. 2021 Jan 11;21(1):28. https://doi.org/10.1186/s12888-020-03017-w. Accessed August 18, 2022.

60. Olsen JM. Integrative review of pregnancy health risks and outcomes associated with adverse childhood experiences. J Obstet Gynecol Neonatal Nurs. 2018 Nov;47(6):783-794. https://doi.org/10.1016/j.jogn.2018.09.005. Accessed August 18, 2022.

61. Ruyak SL, Kivlighan KT. Perinatal behavioral health, the covid-19 pandemic, and a social determinants of health framework. J Obstet Gynecol Neonatal Nurs. 2021 Sep;50(5):525-538. https://doi.org/10.1016/j.jogn.2021.04.012. Accessed August 18, 2022.

62. Blount AJ, Adams CR, Anderson-Berry AL, Hanson C, Schneider K, Pendyala G. Biopsychosocial factors during the perinatal period: Risks, preventative factors, and implications for healthcare professionals. Int J Environ Res Public Health. 2021 Aug 3;18(15):8206. https://doi.org/10.3390/ijerph18158206. Accessed August 18, 2022.

63. Beck CT. Predictors of postpartum depression: An update. Nurs Res. 2001 Sep-Oct;50(5):275-85. https://doi.org/10.1097/00006199-200109000-00004. Accessed August 18, 2022.

64. Lee King PA, Duan L, Amaro H. Clinical needs of in-treatment pregnant women with co-occurring disorders: Implications for primary care. Matern Child Health J. 2015 Jan;19(1):180-7. https://doi.org/10.1007/s10995-014-1508-x. Accessed August 18, 2022.

65. Committee on Health Care for Underserved Women. ACOG Committee opinion no. 729: Importance of social determinants of health and cultural awareness in the delivery of reproductive health care. Obstet Gynecol. 2018 Jan;131(1):e43-e48. https://doi.org/10.1097/aog.0000000000002459. Accessed August 18, 2022.

66. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 518: Intimate partner violence. Obstet Gynecol. 2012 Feb;119(2 Pt 1):412-7. https://doi.org/10.1097/aog.0b013e318249ff74 . Accessed August 18, 2022.

67. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. JAMA. 2018 Oct 23;320(16):1678-1687. https://doi.org/10.1001/jama.2018.14741. Accessed August 18, 2022.

68. Health Resources and Services Administration. Women's preventive services guidelines. https://www.hrsa.gov/womens-guidelines-2016. Accessed August 18, 2022.

69. American Academy of Pediatrics. Preventive care/periodicity schedule. https://www.aap.org/periodicityschedule. Accessed August 18, 2022.

70. Leichliter JS, Haderxhanaj LT, Gift TL, Dittus PJ. Sexually transmissible infection testing among pregnant women in the US, 2011-15. Sex Health. 2020 Feb;17(1):1-8. https://doi.org/10.1071/SH19002. Accessed August 18, 2022.

71. Cavanaugh CE, Hedden SL, Latimer WW. Sexually transmitted infections among pregnant heroin- or cocaine-addicted women in treatment: The significance of psychiatric co-morbidity and sex trade. Int J STD AIDS. 2010 Feb;21(2):141-2. https://doi.org/10.1258/ijsa.2009.009172 . Accessed August 18, 2022.

72. Ahrens KA, Rossen LM, Burgess AR, Palmsten KK, Ziller EC. Rural-urban residence and maternal hepatitis c infection, U.S.: 2010-2018. Am J Prev Med. 2021 Jun;60(6):820-830. https://doi.org/10.1016/j.amepre.2020.12.020. Accessed August 18, 2022.

73. Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014 Jun 5;370(23):2211-8. https://doi.org/10.1056/NEJMra1213566. Accessed August 18, 2022.

74. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Congenital syphilis. https://www.cdc.gov/ncbddd/birthdefects/surveillancemanual/quick-reference-handbook/congenital-syphilis.html . Accessed August 18, 2022.

75. Lochner HJ 3rd, Maraqa NF. Sexually transmitted infections in pregnant women: Integrating screening and treatment into prenatal care. Paediatr Drugs. 2018 Dec;20(6):501-509. https://doi.org/10.1007/s40272-018-0310-4. Accessed August 18, 2022.

76. Kaufman HW, Osinubi A, Meyer WA 3rd, Khan M, Huang X, Panagiotakopoulos L, Thompson WW, Nelson N, Wester C. Hepatitis c virus testing during pregnancy after universal screening recommendations. Obstet Gynecol. 2022 Jul 1;140(1):99-101. https://doi.org/10.1097%2FAOG.0000000000004822. Accessed August 18, 2022.

77. Centers for Disease Control and Prevention. Screening Recommendations. https://www.cdc.gov/nchhstp/pregnancy/screening/index.html. Accessed August 18, 2022.

78. US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for hepatitis b virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019 Jul 23;322(4):349-354. https://doi.org/10.1001/jama.2019.9365 . Accessed August 18, 2022.

79. England LJ, Bennett C, Denny CH, Honein MA, Gilboa SM, Kim SY, Guy GP Jr, Tran EL, Rose CE, Bohm MK, Boyle CA. Alcohol use and co-use of other substances among pregnant females aged 12-44 years - United States, 2015-2018. MMWR Morb Mortal Wkly Rep. 2020 Aug 7;69(31):1009-1014. http://dx.doi.org/10.15585/mmwr.mm6931a1 . Accessed August 18, 2022.

80. Jarlenski MP, Paul NC, Krans EE. Polysubstance use among pregnant women with opioid use disorder in the United States, 2007-2016. Obstet Gynecol. 2020 Sep;136(3):556-564. https://doi.org/10.1097/AOG.0000000000003907. Accessed August 18, 2022.

81. Oh S, Reingle Gonzalez JM, Salas-Wright CP, Vaughn MG, DiNitto DM. Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014. Prev Med. 2017 Apr;97:93-99. https://doi.org/10.1016/j.ypmed.2017.01.006. Accessed August 18, 2022.

82. Gabrielson SMB, Carwile JL, O'Connor AB, Ahrens KA. Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009-2018. Public Health. 2020 Apr;181:171-179. https://doi.org/10.1016/j.puhe.2019.12.014. Accessed August 18, 2022.

83. Pentecost R, Latendresse G, Smid M. Scoping review of the associations between perinatal substance use and perinatal depression and anxiety. J Obstet Gynecol Neonatal Nurs. 2021 Jul;50(4):382-391. https://doi.org/10.1016/j.jogn.2021.02.008. Accessed August 18, 2022.

84. Substance Abuse and Mental Health Services Administration. 2019 National Survey on Drug Use and Health: Women. 2020, Sept. Available from: https://www.samhsa.gov/data/report/2019-nsduh-women . Accessed August 18, 2022.

85. Admon LK, Winkelman TNA, Moniz MH, Davis MM, Heisler M, Dalton VK. Disparities in chronic conditions among women hospitalized for delivery in the United States, 2005-2014. Obstet Gynecol. 2017 Dec;130(6):1319-1326. https://doi.org/10.1097/AOG.0000000000002357. Accessed August 18, 2022.

86. Krans EE, Kim JY, Chen Q, Rothenberger SD, James AE 3rd, Kelley D, Jarlenski MP. Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction. 2021 Dec;116(12):3504-3514. https://doi.org/10.1111/add.15582. Accessed August 18, 2022.

87. Substance Abuse and Mental Health Services Administration. Clinical guidance for treating pregnant and parenting women with opioid use disorder and their infants. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Available from: https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054 . Accessed August 18, 2022.

88. Jones HE, O'Grady KE, Malfi D, Tuten M. Methadone maintenance vs. methadone taper during pregnancy: Maternal and neonatal outcomes. Am J Addict. 2008 Sep-Oct;17(5):372-86. https://doi.org/10.1080/10550490802266276. Accessed August 18, 2022.

89. Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009 Sep;114(3):703-713. https://doi.org/10.1097%2FAOG.0b013e3181ba0632. Accessed August 18, 2022.

90. Chisolm MS, Payne JL. Management of psychotropic drugs during pregnancy. BMJ. 2016 Jan 20;532:h5918. https://doi.org/10.1136/bmj.h5918. Accessed August 18, 2022.

91. National Institutes of Health. Perinatal depression. https://www.nimh.nih.gov/health/publications/perinatal-depression. Accessed August 18, 2022.

92. University of North Carolina Center For Women’s Mood Disorders. Perinatal mood and anxiety disorders. https://www.med.unc.edu/psych/wmd/resources/mood-disorders/perinatal/. Accessed August 18, 2022.

93. Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, Dennis CL, Steiner M, Brown C, Cheung A, Dawson H, Rector NA, Guenette M, Richter M. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis. J Clin Psychiatry. 2018 Sep 4;79(5):17r12011. https://doi.org/10.4088/JCP.17r12011. Accessed August 18, 2022.

94. Evans K, Spiby H, Morrell JC. Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women's views on the acceptability of and satisfaction with interventions. Arch Womens Ment Health. 2020 Feb;23(1):11-28. https://doi.org/10.1007/s00737-018-0936-9. Accessed August 18, 2022.

95. van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AM. Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis. PLoS One. 2017 Mar 30;12(3):e0173397. https://doi.org/10.1371/journal.pone.0173397. Accessed August 18, 2022.

96. Yu X, Liu Y, Huang Y, Zeng T. The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review. Complement Ther Med. 2022 Mar;64:102799. https://doi.org/10.1016/j.ctim.2022.102799. Accessed August 18, 2022.

97. Sasaki N, Yasuma N, Obikane E, Narita Z, Sekiya J, Inagawa T, Nakajima A, Yamada Y, Yamazaki R, Matsunaga A, Saito T, Imamura K, Watanabe K, Kawakami N, Nishi D. Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: A systematic review. Neuropsychopharmacol Rep. 2021 Mar;41(1):2-13. https://doi.org/10.1002/npr2.12155. Accessed August 18, 2022.

98. Anxiety and Depression Association of America. Pregnancy and medication. https://adaa.org/living-with-anxiety/women/pregnancy-and-medication. Accessed August 18, 2022.

99. Langan R, Goodbred AJ. Identification and Management of Peripartum Depression. Am Fam Physician. 2016 May 15;93(10):852-8. https://www.aafp.org/pubs/afp/issues/2016/0515/p852.html. Accessed August 18, 2022.

100. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499-507. Accessed August 18, 2022.

101. Viswanathan M, Middleton JC, Stuebe A, Berkman N, Goulding AN, McLaurin-Jiang S, Dotson AB, Coker-Schwimmer M, Baker C, Voisin C, Bann C, Gaynes BN. Maternal, fetal, and child outcomes of mental health treatments in women: A systematic review of perinatal pharmacologic interventions. Comparative Effectiveness Review No. 236. (Prepared by the RTI International−University of North Carolina at Chapel Hill Evidence-based Practice Center under Contract No. 290-2015-00011-I.) AHRQ Publication No. 21-EHC001. Rockville, MD: Agency for Healthcare Research and Quality; 2021. Available from: https://doi.org/10.23970/AHRQEPCCER236 . Accessed August 18, 2022.

102. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Alcohol use during pregnancy. https://www.cdc.gov/ncbddd/fasd/alcohol-use.html. Accessed August 18, 2022.

103. Sundermann AC, Zhao S, Young CL, Lam L, Jones SH, Velez Edwards DR, Hartmann KE. Alcohol use in pregnancy and miscarriage: A systematic review and meta-analysis. Alcohol Clin Exp Res. 2019 Aug;43(8):1606-1616. https://doi.org/10.1111/acer.14124. Accessed August 18, 2022.

104. Patra J, Bakker R, Irving H, Jaddoe VW, Malini S, Rehm J. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)-A systematic review and meta-analyses. BJOG. 2011 Nov;118(12):1411-21. https://doi.org/10.1111/j.1471-0528.2011.03050.x. Accessed August 18, 2022.

105. Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: A meta-analysis. Alcohol Clin Exp Res. 2014 Jan;38(1):214-26. https://doi.org/10.1111/acer.12214. Accessed August 18, 2022.

106. American College of Obstetricians and Gynecologists. Committee opinion no. 496: At-risk drinking and alcohol dependence: Obstetric and gynecologic implications. Obstet Gynecol. 2011 Aug;118(2 Pt 1):383-388. https://doi.org/10.1097/aog.0b013e31822c9906. Accessed August 18, 2022.

107. Centers for Disease Control and Prevention. Planning and implementing screening and brief intervention for risky alcohol use: A Step-by-step guide for primary care practices. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 2014. Available from: https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide-P.pdf. Accessed August 18, 2022.

108. Hankin JR. Fetal alcohol syndrome prevention research. Alcohol Res Health. 2002;26(1):58-65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683808/. Accessed August 18, 2022.

109. Floyd RL, Sobell M, Velasquez MM, Ingersoll K, Nettleman M, Sobell L, Mullen PD, Ceperich S, von Sternberg K, Bolton B, Johnson K, Skarpness B, Nagaraja J; Project CHOICES Efficacy Study Group. Preventing alcohol-exposed pregnancies: A randomized controlled trial. Am J Prev Med. 2007 Jan;32(1):1-10. https://doi.org/10.1016/j.amepre.2006.08.028. Accessed August 18, 2022.

110. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, Vincitorio NA, Wilkins-Haug L. Brief intervention for prenatal alcohol use: A randomized trial. Obstet Gynecol. 2005 May;105(5 Pt 1):991-8. https://doi.org/10.1097/01.AOG.0000157109.05453.84. Accessed August 18, 2022.

111. Winslow BT, Onysko M, Hebert M. Medications for alcohol use disorder. Am Fam Physician. 2016 Mar 15;93(6):457-65. https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html. Accessed August 18, 2022.

112. British Columbia Centre on Substance Use (BCCSU), BC Ministry of Health, BC Ministry of Mental Health and Addictions. Pregnancy supplement – Provincial guideline for the clinical management of high-risk drinking and alcohol use disorder. Vancouver, BC: BCCSU; 2020 Oct. Available at: https://www.bccsu.ca/clinical-care-guidance/. Accessed August 18, 2022.

113. Substance Abuse and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism. Medication for the treatment of alcohol use disorder: A brief guide. HHS Publication No. (SMA) 15-4907. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907.pdf [PDF - 507 KB]. Accessed August 18, 2022.

114. Centers for Disease Control and Prevention. About opioid use during pregnancy. https://www.cdc.gov/pregnancy/opioids/basics.html. Accessed August 18, 2022.

115. Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in pregnancy and birth outcomes: A review of the literature. J Pediatr Genet. 2015;4(2):56–70. https://doi.org/10.1055/s-0035-1556740 . Accessed August 18, 2022.

116. Lind JN, Interrante JD, Ailes EC, et al. Maternal use of opioids during pregnancy and congenital malformations: A systematic review. Pediatrics. 2017;139(6):e20164131. https://doi.org/10.1542/peds.2016-4131 . Accessed August 18, 2022.

117. Terplan M, Laird HJ, Hand DJ, Wright TE, Premkumar A, Martin CE, Meyer MC, Jones HE, Krans EE. Opioid detoxification during pregnancy: A systematic review. Obstet Gynecol. 2018 May;131(5):803-814. https://doi.org/10.1097/AOG.0000000000002562. Accessed August 18, 2022.

118. National Institute on Drug Abuse. Treating opioid use disorder during pregnancy. https://nida.nih.gov/publications/treating-opioid-use-disorder-during-pregnancy. Accessed August 18, 2022.

119. National Institute on Drug Abuse. What treatment is available for pregnant mothers and their babies?. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-treatment-available-pregnant-mothers-their-babies . Accessed August 18, 2022.

120. Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Buprenorphine and naloxone versus buprenorphine for opioid use disorder in pregnancy: A cohort study. J Addict Med. 2020 May/Jun;14(3):185-192. https://doi.org/10.1097/ADM.0000000000000562. Accessed August 18, 2022.

121. O'Connor AB, O'Brien L, Alto WA. Maternal buprenorphine dose at delivery and its relationship to neonatal outcomes. Eur Addict Res. 2016;22(3):127-30. https://doi.org/10.1159/000441220. Accessed August 18, 2022.

122. Ahrens KA, McBride CA, O'Connor A, Meyer MC. Medication for addiction treatment and postpartum health care utilization among pregnant persons with opioid use disorder. J Addict Med. 2022 Jan-Feb 01;16(1):56-64. https://doi.org/10.1097/ADM.0000000000000827. Accessed August 18, 2022.

123. Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention. Neonatal opioid withdrawal syndrome. Pediatrics. 2020 Nov;146(5):e2020029074. https://doi.org/10.1542/peds.2020-029074. Accessed August 18, 2022.

124. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Smoking during pregnancy. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm. Accessed August 18, 2022.

125. Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: Systematic review and meta-analysis. BMC Public Health. 2015 Mar 13;15:239. https://doi.org/10.1186/s12889-015-1552-5 . Accessed August 18, 2022.

126. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: A systematic review based on 173,687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011 Sep-Oct;17(5):589-604. https://doi.org/10.1093/humupd/dmr022. Accessed August 18, 2022.

127. Dietz PM, England LJ, Shapiro-Mendoza CK, Tong VT, Farr SL, Callaghan WM. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med. 2010 Jul;39(1):45-52. https://doi.org/10.1016/j.amepre.2010.03.009. Accessed August 18, 2022.

128. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. E-Cigarettes and Pregnancy. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/e-cigarettes-pregnancy.htm. Accessed August 18, 2022.

129. Whittington JR, Simmons PM, Phillips AM, Gammill SK, Cen R, Magann EF, Cardenas VM. The use of electronic cigarettes in pregnancy: A review of the literature. Obstet Gynecol Surv. 2018 Sep;73(9):544-549. https://doi.org/10.1097/OGX.0000000000000595. Accessed August 18, 2022.

130. American College of Obstetricians and Gynecologists. Tobacco and nicotine cessation during pregnancy: ACOG committee opinion, number 807. Obstet Gynecol. 2020 May;135(5):e221-e229. https://doi.org/10.1097/aog.0000000000003822. Accessed August 18, 2022.

131. US Preventive Services Task Force, Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW Jr, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement. JAMA. 2021 Jan 19;325(3):265-279. https://doi.org/10.1001/jama.2020.25019 . Accessed August 18, 2022.

132. Chamberlain C, O'Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2017 Feb 14;2(2):CD001055. https://doi.org/10.1002/14651858.CD001055.pub5. Accessed August 18, 2022.

133. Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: A review of reviews for the U.S. Preventive Services Task Force. Evidence Synthesis No. 134. Rockville, MD: Agency for Healthcare Research and Quality; 2015. https://www.ncbi.nlm.nih.gov/books/NBK321744/. Accessed August 18, 2022.

134. Hand DJ, Ellis JD, Carr MM, Abatemarco DJ, Ledgerwood DM. Contingency management interventions for tobacco and other substance use disorders in pregnancy. Psychol Addict Behav. 2017 Dec;31(8):907-921. https://doi.org/10.1037/adb0000291. Accessed August 18, 2022.

135. Claire R, Chamberlain C, Davey MA, Cooper SE, Berlin I, Leonardi-Bee J, Coleman T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2020 Mar 4;3(3):CD010078. https://doi.org/10.1002/14651858.cd010078.pub3. Accessed August 18, 2022.

136. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Pregnancy: What you need to know about marijuana use and pregnancy. https://www.cdc.gov/marijuana/health-effects/pregnancy.html. Accessed August 18, 2022.

137. Substance Abuse and Mental Health Services Administration. Marijuana and pregnancy. https://www.samhsa.gov/marijuana/marijuana-pregnancy. Accessed August 18, 2022.

138. Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG. Maternal Marijuana use and adverse neonatal outcomes: A systematic review and meta-analysis. Obstet Gynecol. 2016 Oct;128(4):713-723. https://doi.org/10.1097/AOG.0000000000001649. Accessed August 18, 2022.

139. Marchand G, Masoud AT, Govindan M, Ware K, King A, Ruther S, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Karrys A, Sainz K. Birth outcomes of neonates exposed to marijuana in utero: A systematic review and meta-analysis. JAMA Netw Open. 2022 Jan 4;5(1):e2145653. Accessed August 18, 2022. https://doi.org/10.1001/jamanetworkopen.2021.45653. Accessed August 18, 2022.

140. Paul SE, Hatoum AS, Fine JD, et al. Associations between prenatal cannabis exposure and childhood outcomes: Results from the ABCD Study. JAMA Psychiatry. 2021;78(1):64–76. https://doi.org/10.1001/jamapsychiatry.2020.2902. Accessed August 18, 2022.

141. Rompala G, Nomura Y, Hurd YL. Maternal cannabis use is associated with suppression of immune gene networks in placenta and increased anxiety phenotypes in offspring. Proc Natl Acad Sci USA. 2021 Nov 23;118(47):e2106115118. https://doi.org/10.1073/pnas.2106115118. Accessed August 18, 2022.

142. Food and Drug Administration. What you should know about using cannabis, including CBD, when pregnant or breastfeeding. https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding . Accessed August 18, 2022.

143. Ryan SA, Ammerman SD, O'Connor ME, Committee On Substance Use and Prevention; Section on Breastfeeding. Marijuana use during pregnancy and breastfeeding: Implications for neonatal and childhood outcomes. Pediatrics. 2018 Sep;142(3):e20181889. https://doi.org/10.1542/peds.2018-1889. Accessed August 18, 2022.

144. Braillon A, Bewley S. Committee opinion no. 722: Marijuana use during pregnancy and lactation. Obstet Gynecol. 2018 Jan;131(1):164. https://doi.org/10.1097/aog.0000000000002429. Accessed August 18, 2022.

145. Dickson B, Mansfield C, Guiahi M, Allshouse AA, Borgelt LM, Sheeder J, Silver RM, Metz TD. Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstet Gynecol. 2018 Jun;131(6):1031-1038. https://doi.org/10.1097/aog.0000000000002619. Accessed August 18, 2022.

146. Gouin K, Murphy K, Shah PS. Effects of cocaine use during pregnancy on low birthweight and preterm birth: Systematic review and metaanalyses. Am J Obstet Gynecol 2011;204(4):340 e341–340. https://doi.org/10.1016/j.ajog.2010.11.013. Accessed August 18, 2022.

147. Kalaitzopoulos D-R, Chatzistergiou K, Amylidi A-L, Kokkinidis DG, Goulis DG. Effect of methamphetamine hydrochloride on pregnancy outcome: A systematic review and meta-analysis. J Addict Med 2018;12(3):220–226. https://doi.org/10.1097/adm.0000000000000391. Accessed August 18, 2022.

148. Committee opinion no. 479: Methamphetamine abuse in women of reproductive age. Obstet Gynecol. 2011 Mar;117(3):751-755. https://doi.org/10.1097/aog.0b013e318214784e. Accessed August 18, 2022.

149. Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment of stimulant use disorders. SAMHSA Publication No. PEP20-06-01-001 Rockville, MD: National Mental Health and Substance Use Policy Laboratory, SAMHSA; 2020. https://www.samhsa.gov/resource/ebp/treatment-stimulant-use-disorders. Accessed August 18, 2022.

150. Association of Maternal & Child Health Programs, National Association of State Alcohol and Drug Abuse Directors. SBIRT for pregnant and postpartum women: Opportunities for State MCH programs. Washington, DC: Association of Maternal & Child Health Programs; 2022 Oct. Available from: https://amchp.org/wp-content/uploads/2022/01/AMCHP-NASADAD-SBIRT-Issue-Brief-October-2020.pdf [PDF - 430 KB]. Accessed August 18, 2022.

151. Ronsley C, Nolan S, Knight R, Hayashi K, Klimas J, Walley A, Wood E, Fairbairn N. Treatment of stimulant use disorder: A systematic review of reviews. PloS One. 2020 Jun 18;15(6):e0234809. https://doi.org/10.1371/journal.pone.0234809. Accessed August 18, 2022.

152. Knapp WP, Soares BG, Farrel M, Lima MS. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003023. Update in: Cochrane Database Syst Rev. 2015;4:CD003023. https://doi.org/10.1002/14651858.cd003023.pub2. Accessed August 18, 2022.

153. AshaRani PV, Hombali A, Seow E, Ong WJ, Tan JH, Subramaniam M. Non-pharmacological interventions for methamphetamine use disorder: A systematic review. Drug and Alcohol Depend. 2020 Jul 1;212:108060. https://doi.org/10.1016/j.drugalcdep.2020.108060. Accessed August 18, 2022.

154. Brown HD, DeFulio A. Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug and Alcohol Depend. 2020 Sep 21:108307. https://doi.org/10.1016/j.drugalcdep.2020.108307. Accessed August 18, 2022.

155. Bentzley BS, Han SS, Neuner S, Humphreys K, Kampman KM, Halpern CH. Comparison of treatments for cocaine use disorder among adults: A systematic review and meta-analysis. JAMA Netw Open. 2021 May 3;4(5):e218049. https://doi.org/10.1001/jamanetworkopen.2021.8049 . Accessed August 18, 2022.

156. DiClemente CC, Corno CM, Graydon MM, Wiprovnick AE, Knoblach DJ. Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychol Addict Behav. 2017 Dec;31(8):862-887. https://doi.org/10.1037/adb0000318. Accessed August 18, 2022.

157. Centers for Medicare and Medicaid Services. Improving Access to Maternal Health Care In Rural Communities: An Issue Brief. Baltimore, MD: Centers for Medicare and Medicaid Services; 2019. Available from: https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf [PDF - 1,233 KB]. Accessed August 18, 2022.

158. Office of the Surgeon General. The Surgeon general’s call to action to improve maternal health [Internet]. Washington (DC): US Department of Health and Human Services; 2020 Dec. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568220/. Accessed August 18, 2022.

159. Laurie Zephyrin et al. Transforming primary health care for women — Part 1: A framework for addressing gaps and barriers. New York, NY: Commonwealth Fund and Manatt Health; 2020 Jul. Available from: https://doi.org/10.26099/8c0s-fj12. Accessed August 18, 2022.

160. Laurie Zephyrin et al. Transforming primary health care for women — Part 2: The path forward. New York, NY: Commonwealth Fund; 2020 Jul. Available from: https://doi.org/10.26099/8m2v-dv11. Accessed August 18, 2022.

161. Seibert J, Stockdale H, Feinberg R, Dobbins E, Theis E, Karon SL. State policy levers for expanding family-centered medication-assisted treatment. Washington, DC: Assistant Secretary for Planning and Evaluation; 2022. Available from: https://aspe.hhs.gov/reports/state-policy-levers-expanding-family-centered-medication-assisted-treatment-0 . Accessed August 18, 2022.