Maternal Opioid Use Disorder: The Case for Comprehensive, Digitally-Enhanced Care
October 24, 2025
The intersection of pregnancy and substance use disorder represents one of healthcare’s most complex challenges, requiring specialized care that addresses both maternal and infant health. Recent data reveals the growing scope of this crisis and underscores the urgent need for comprehensive, evidence-based support systems.
A Growing Crisis
Over the past twenty-five years, opioid-related morbidity and mortality have surged in the United States. The national prevalence of maternal opioid use disorder (OUD) escalated more than fivefold from 1.5 cases to 8.2 cases per 1,000 delivery hospitalizations from 1999 to 2017. This epidemic has had devastating consequences: maternal OUD is associated with adverse infant health outcomes, including preterm birth, low birth weight, respiratory complications, and neonatal opioid withdrawal syndrome, as well as a 43% increased odds of infant mortality. Maternal mortality from OUD has increased in parallel, rising 76.9% from 11.2 to 48.5 deaths per 100,000 live births during the same period.
This alarming trend reflects broader patterns in the opioid epidemic while highlighting the unique vulnerabilities faced by expectant mothers. Women who use opioids during pregnancy experience significantly higher rates of co-occurring mental health conditions, including depression, anxiety, and chronic medical complications that can complicate both pregnancy and recovery.
Beyond Health: The Economic Burden of Maternal Opioid Use Disorder
The consequences of maternal opioid use disorder extend far beyond immediate health outcomes, imposing a substantial and lasting financial burden on healthcare systems, families, and society. These costs begin at birth and compound throughout a child’s life, while simultaneously increasing maternal care costs.
The financial impact starts during pregnancy and delivery: hospitalization expenses for pregnant individuals with opioid use disorder average 38% higher than for those without OUD. However, the most significant costs emerge in the care of affected infants.
The Immediate Cost Crisis: Neonatal Abstinence Syndrome
Neonatal Abstinence Syndrome (NAS) represents one of the most expensive complications of maternal opioid use. In 2016, infants with NAS had an average hospital cost of $22,552 per infant with a mean length of stay of 15.9 days, generating total nationwide costs of $572.7 million. To put this in perspective, infants affected by NAS experience hospital stays nearly 3.5 times longer and costs more than three times greater ($16,893 compared to $5,610) than non-affected infants.
The burden falls disproportionately on public payers. By 2014, NAS impacted 14.4 infants per 1,000 births and totaled $462 million in hospital costs among births financed by Medicaid alone, with Medicaid covering 82% of all NAS-related births.. This concentration of costs in state and federal Medicaid programs means that taxpayers bear the majority of expenses associated with untreated maternal OUD.
The Hidden Cost: Long-Term Healthcare Burden
The financial consequences extend far beyond the initial hospitalization. A study of Alabama Medicaid enrollees found that neonates with an NAS diagnosis had estimated long-term healthcare costs $17,921 higher than those without an NAS diagnosis over their first decade of life. These elevated costs reflect ongoing medical needs, developmental interventions, and treatment for complications that persist years after birth.
The Economic Burden.
When combined, the immediate hospitalization costs and decade-long elevated healthcare utilization create a per-child economic burden exceeding $40,000—costs that are largely preventable through effective maternal treatment.
Addressing the Challenge: A Multi-Faceted Approach
Effectively addressing maternal substance use disorder requires coordinated interventions across multiple domains. Evidence-based approaches that have demonstrated success include:
- Medication-Assisted Treatment (MAT): Buprenorphine and methadone maintenance during pregnancy significantly reduces relapse rates, improves prenatal care engagement, and decreases adverse neonatal outcomes compared to medically unsupervised withdrawal. MAT has become the gold standard of care, reducing the severity of neonatal withdrawal while supporting maternal recovery.
- Integrated Care Models: Programs that coordinate obstetric care, addiction treatment, mental health services, and social support in a single setting substantially improve outcomes. These models reduce fragmented care and address the multiple challenges pregnant individuals face simultaneously.
- Trauma-Informed Care: Given the high prevalence of trauma among women with substance use disorders, care approaches that recognize and respond to trauma histories improve engagement and retention in treatment.
- Peer Support Programs: Connection with peers who have successfully navigated recovery during pregnancy provides crucial emotional support and reduces isolation, improving treatment adherence and maternal confidence.
The effectiveness of these interventions hinges on a critical principle explored in depth in Maximizing Patient Lifetime Value in Substance Use Disorder Treatment: sustained engagement transforms both outcomes and economics across the entire continuum of substance use disorder treatment. When we apply this lifetime value framework specifically to maternal OUD, the economic imperative becomes even more compelling. The total lifetime costs of untreated maternal substance use disorder—encompassing immediate NAS hospitalization ($22,552 per affected infant), elevated childhood healthcare costs ($17,921 additional over the first decade), developmental interventions, educational support services, and potential child welfare system involvement—dwarf the investment required for effective maternal treatment that maintains sustained engagement throughout pregnancy and the postpartum period.
This cost differential isn’t simply about avoiding downstream expenses; it reflects a fundamental transformation in how we should approach maternal OUD. As the lifetime value framework demonstrates, the economic returns of sustained engagement multiply across all stakeholders: health plans reduce acute care utilization and long-term costs, providers achieve better clinical outcomes with fewer complications, states decrease Medicaid expenditures while protecting vulnerable populations, and most importantly, mothers and children experience healthier, more stable lives.
However, traditional treatment approaches often fall short of achieving the sustained engagement necessary to realize these outcomes. The stigma surrounding maternal substance use creates additional barriers to seeking care, while the requirement to protect both maternal and fetal health demands specialized clinical expertise and continuous support systems that extend beyond traditional appointment schedules.
The Evidence for Digital-Enhanced Care
The potential of digital tools to enable sustained engagement in maternal SUD treatment isn’t theoretical; it’s demonstrated through rigorous research and real-world implementation. Studies show that integrated digital platforms significantly improve the engagement metrics that drive better outcomes:
- Extended Treatment Retention: Research from Oklahoma demonstrates that digital support tools keep individuals in treatment an average of 37 days longer and significantly increase outpatient treatment completion rates compared to traditional care alone. For pregnant individuals, where every additional week of engagement reduces risk to both mother and infant, this extended retention is transformative.
- Improved Program Completion Through Contingency Management: Contingency management—automated reward systems that reinforce positive behaviors—is considered a critical component of comprehensive OUD treatment programs. This evidence-based intervention has proven particularly effective at improving treatment adherence and program completion, with programs using digital contingency management tools achieving a 70% program completion rate. Digital platforms can deliver contingency management at scale, providing immediate positive reinforcement for attending appointments, completing treatment milestones, and maintaining recovery activities. By making this critical intervention operationally feasible, digital tools address one of the most persistent challenges in SUD treatment: maintaining consistent engagement through program completion.
- 24/7 Peer Support Access: Digital platforms can offer round-the-clock connection to peer specialists and communities, who can provide support during the vulnerable evening and weekend hours when traditional clinical resources are unavailable. This continuous access addresses the reality that cravings, questions, and challenges don’t respect office hours—particularly critical during pregnancy when concerns about fetal health can create acute anxiety.
- Reduced Stigma as an Engagement Pathway: The confidential nature of digital platforms demonstrably reduces the stigma barriers that prevent pregnant individuals from seeking help. By providing a private entry point into recovery support, digital tools engage individuals who might otherwise avoid treatment entirely due to fear of judgment or child welfare involvement. This stigma reduction creates measurable improvements in treatment initiation and sustained participation.
- Addressing Access Barriers at Scale: Digital solutions overcome the transportation, childcare, and geographic barriers that disproportionately affect pregnant individuals, particularly in rural areas and underserved communities, where specialized maternal SUD treatment may be hours away. This expanded access ensures that effective care reaches the populations most affected by the maternal opioid crisis.
Proven Success with Vulnerable Populations
CHESS Health has demonstrated measurable success in supporting individuals in recovery through evidence-based digital tools. The eRecovery platform provides comprehensive support, including 24/7 peer-backed support, with components dedicated specifically to women, including an online meeting series and a library of resources focused on pregnancy and parenting. Coupled with resources for their support network, including friends, family, and caregivers, this creates a complete system of support for women navigating recovery.
This powerful suite of digital tools also features an automated contingency management platform, a critical evidence-based component of OUD treatment, along with outreach and engagement tools designed to maintain consistent participation. These integrated capabilities are essential to helping women navigate the complex intersection of recovery, pregnancy, and parenting well beyond traditional clinical appointments while staying committed to their recovery program.
The results speak for themselves: a recent study of a health plan using the Connections recovery support app showed improvements in maternal and infant health outcomes while simultaneously reducing costs associated with NAS and long-term complications. These real-world implementations confirm that thoughtfully integrated digital tools become powerful enablers of sustained recovery—transforming both clinical outcomes and program economics for health plans serving pregnant individuals with substance use disorders.
The Path Forward: Operationalizing Sustained Engagement
The maternal opioid crisis demands urgent, comprehensive action. The evidence is clear: effective treatment is possible, economically justified, and operationally achievable when we combine evidence-based clinical care with digital tools that enable sustained engagement. Every pregnant individual with substance use disorder deserves access to specialized, stigma-free treatment that protects both her health and her child’s future.
The question is no longer whether we can address maternal substance use disorder effectively—we know we can. The question is whether we will mobilize the resources, implement the proven interventions, and deploy the digital infrastructure necessary to reach every mother who needs support. The lifetime value framework shows us that investment in comprehensive maternal OUD treatment isn’t just compassionate—it’s one of the most cost-effective strategies available to health systems, states, and society.
By combining clinical excellence, evidence-based treatment approaches, and integrated digital support, we can transform outcomes for pregnant individuals with substance use disorders. The tools exist. The evidence is compelling. Now we must act to ensure that every expectant mother has access to the comprehensive care that enables lasting recovery and healthy families.
