Infant caregiving, relational factors, mood, and pain in perinatal opioid use disorder: A prospective cohort with ecological momentary assessment

Evidence-based opioid use disorder (OUD) relapse prevention interventions designed to the unique needs of the postpartum period are lacking. We aimed to identify novel intervention targets using ecological momentary assessment (EMA) with Bayesian mixed-effects models to assess infant caregiving (e.g., skin-to-skin contact), relational factors (e.g., loneliness), and individual factors (e.g., pain): (1) by OUD status, and (2) in relation to craving and coping. Participants with and without OUD (OUD+ and OUD-, respectively) were followed from late pregnancy to postpartum week 12 with daily EMA assessing infant caregiving, relational factors, individual factors, craving for non-therapeutic opioids (e.g., heroin), craving for therapeutic opioids (e.g., methadone), and coping with cravings. Participants (n = 61) were 29.4 ± 5.1 years old. Compared to OUD- (n = 18), OUD+(n = 43) had greater infant-focused anxiety (β = 0.24, 95% CI: 0.002, 0.48) and well-being stress (β = 0.32; 95% CI: 0.02, 0.64). Coping with cravings declined over time (β = -0.38, 95% CI: -0.77, -0.01) whereas opioid cravings did not. Numerous associations were identified including, but not limited to, non-therapeutic craving with infant-focused anxiety (β = 1.95; 95% CI: 0.33, 3.55) and pain (β = 0.08; 95% CI: 0.03, 0.13), therapeutic craving with tangible support (β = 3.99; 95% CI: 0.56, 7.48) and work-related stress (β = 1.88; 95% CI: 0.63, 3.14), and coping with cravings with skin-to-skin contact (β = 0.07; 95% CI: 0.03, 0.11) and general well-being stress (β = -2.07; 95% CI: -4.12, -0.01). Several modifiable risk factors had unique and meaningful associations with opioid cravings and coping with craving. Future research is needed to replicate these observations in diverse samples and examine the applicability to postpartum OUD recovery support.