Community-Engaged Development of a Peer Breastfeeding Support Intervention for Mothers with Opioid Use Disorder - PROJECT SUMMARY / ABSTRACT The incidence of opioid use disorder (OUD) in pregnancy and neonatal opioid withdrawal syndrome are rapidly increasing. OUD-exposed mother-infant dyads face increased medical and social risk in the perinatal period and beyond. Breastfeeding significantly improves key health outcomes in OUD-exposed dyads and thus is strongly recommended by national and international societies. Breastfeeding leads to reductions in mortality and morbidity among opioid-exposed infants and life-long health benefits to both mothers and infants. However, mothers with OUD are significantly less likely to initiate and continue breastfeeding than mothers without OUD, many stopping in the first 1-2 weeks postpartum. This disparity persists because we lack evidence-based, tailored services to support breastfeeding for OUD-exposed dyads, who face a complex web of barriers to breastfeeding. Peer support has been utilized to support recovery in populations with SUD and to support breastfeeding in other medically vulnerable populations. Despite the potential synergistic benefits of providing breastfeeding peer counseling within a recovery care model among OUD-exposed dyads, this strategy has yet to be described or tested. Further, the extent that breastfeeding may influence OUD recovery is poorly understood. To address this gap, I propose to develop a peer lactation intervention for OUD-exposed dyads leveraging a community-engaged approach. This project includes three main aims: (1) Engage mothers with OUD to identify breastfeeding facilitators among mothers who breastfed ≥3 months in order to tailor breastfeeding support, and to understand the potential influence of breastfeeding on recovery; (2) Facilitate focus group conversations with perinatal OUD providers and clinical staff, community program staff, and peer recovery and peer lactation counselors to identify environmental and organizational factors, skills, strategies, and resources needed to adapt and implement a peer lactation model; and (3) Conduct a pilot single-site RCT of 30 mothers with OUD with baseline peer recovery coaching to receive additional peer lactation support by a counselor with lived OUD/breastfeeding experience vs. usual care (recovery coaching only) to examine feasibility, acceptability, fidelity, and preliminary efficacy in breastfeeding and addiction outcomes. This proposal directly fulfills NIDA’s priority area to “develop and test novel prevention, treatment, harm reduction and recovery support strategies” through development of a breastfeeding support intervention with potential to decrease morbidity and mortality among OUD-exposed dyads and provide foundational evidence on how breastfeeding may impact OUD recovery. The PI, Dr. Standish, is an early-career clinician investigator, family physician, and breastfeeding medicine physician who will use this career development award to enhance her skills in community engaged approaches to research, participatory qualitative methods and clinical trial conduct to carry out her stated career objectives and specific aims.
