title: Psychiatric Co-Morbidities in Pregnant Women with Opioid Use Disorders: Prevalence, Impact, and Implications for Treatment.
abstract: OBJECTIVE
  This review seeks to investigate three questions: What is the prevalence of comorbid psychiatric diagnoses among pregnant women with opioid use disorder (OUD)? How do comorbid psychiatric illnesses impact pregnant women with OUD? And how do comorbid psychiatric illnesses affect the ability of pregnant women with OUD to adhere to and complete OUD treatment?
  
  
  RESULTS
  Based on this literature review, 25-33% of pregnant women with OUD have a psychiatric comorbidity, with depression and anxiety being especially common. However, of the 17 studies reviewed only 5 have prevalence rates of dual diagnosis in pregnant women with OUD as their primary outcome measures, their N's were typically small, methods for determining psychiatric diagnosis were variable, and many of the studies were undertaken with women presenting for treatment which carries with its implicit selection bias. Of the women enrolled in treatment programs for SUD, those with psychiatric comorbidity were more likely to have impaired psychological and family/social functioning than those without psychiatric comorbidity. Greater severity of comorbid psychiatric illness appears to predict poorer adherence to treatment, but more research is needed to clarify this relationship with the psychiatric illness is less severe.
  
  
  CONCLUSIONS
  While cooccurrence of psychiatric disorders in pregnant women with opioid use disorder appears to be common, large population-based studies with validated diagnostic tools and longitudinal assessments are needed to obtain definitive rates and characteristics of cooccurring illnesses. Integrated prenatal, addiction, and psychiatric treatment in a setting that provides social support to pregnant patients with OUD is most effective in maintaining women in treatment. More research is still needed to identify optimal treatment settings, therapy modalities, and medication management for dually diagnosed pregnant women with OUD.
authors.affiliation: Department of Psychiatry, Indiana University School of Medicine, 355 West 16th Street, Suite 2800, Indianapolis, IN 46202 USA.
authors.forename: Camila L
authors.initials: CL
authors.lastname: Arnaudo
authors.affiliation: Department of Health Policy and Management, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Andraka-Christou
authors.affiliation: Ruth Lilly Medical Library, Indiana University, Indianapolis, IN USA.
authors.forename: Kacy
authors.initials: K
authors.lastname: Allgood
keywords: Addiction; Comorbidity; Dual diagnosis; Opioid; Pregnant; Psychiatric disorder; Substance use disorder