key: cord-0728928-mr5g9w1t
authors: McKiever, Monique E.; Cleary, Erin M.; Schmauder, Tonya; Talley, Allison; Hinely, Katherine A.; Costantine, Maged M.; Rood, Kara M.
title: Unintended Consequences of the Transition to Telehealth for Pregnancies Complicated by Opioid Use Disorder During COVID-19 Pandemic
date: 2020-08-07
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.08.003
sha: aae5426530b8ebf68aeffa47cc7345a376adca2e
doc_id: 728928
cord_uid: mr5g9w1t

nan

In response to the COVID-19 pandemic, and to control viral spread among patients and staff, 28 delivery of healthcare rapidly adjusted by reducing in-person patient interactions. Worldwide and 29 for a variety of specialties, health care protocols were tailored to allow for expansion of 30 telehealth services. For vulnerable populations, such as pregnant women with opioid use 31 disease (OUD), this shift in practice represented an abrupt transition, and compounded the 32 significant barriers to care that already exist for this population. Here we report our experience 33 with implementation of telehealth services for a cohort of pregnant women with OUD. 34

In our practice, maternal fetal medicine and addiction specialists care for pregnant women with 36 OUD in a co-located office-based outpatient program. A major component of this program is 37 weekly in-person psychotherapeutic/psychoeducational/supportive interventions group therapy. 

When compared to in-person sessions, attendance to group therapy sessions virtually was 79 significantly lower by more than three-fold. (Fig. 1A) . While there was no significant difference in the number of positive UDS test results between 85 time periods, the data is notable for a relapse and overdose in one previously stable patient in 86 addition to a significant increase in the total number of patients requiring up-titration in MAT 87 dose due to intensified cravings during the time period of virtual-only sessions. Furthermore, 88

there is a notable trend towards higher ED and/or OB triage visits, reported assaults, and 89 craving scores (Table 1) . Craving scores peaked for 6 (46%) patients during virtual-only time 90 period (Fig. 1B) . Furthermore, two (15%) women reported IES-R scores of greater than 34, 91 concerning for COVID-19-specific distress. time-period. In the combined group, 75% of total attended group sessions were in-person. * 145

Denotes statistical significance, p<0.05. Fig.1 B. Spaghetti plot, (n=13) each line representing 146 one participant's average total craving score during each time-period. 147 148

Treating Patients with Opioid Use Disorder 116 in Their Homes: An Emerging Treatment Model

Telehealth for High-Risk Pregnancies in the Setting of the 119 COVID-19 Pandemic

Our study suggests that the switch from in-person to virtual-only group visits compounded 108 change within this population and led to decreased attendance of therapy sessions and up-109 titration of MAT secondary to cravings. Small sample size is a limitation of this study however it 110 is strengthened by its longitudinal design. As we continue to navigate care through the 111 continually evolving pandemic and as healthcare moves into a paradigm where telehealth has a 112 more permanent place, we need to consider the impact of that transition on our most vulnerable 113 populations. 114