OPIOID USE AND BORDERLINE PERSONALITY DISORDER FEATURES: IMPLICATIONS FOR POSTPARTUM MATERNAL SELF-EFFICACY

The current study sought to understand and explore the experiences of pregnant individuals who use opioids as previous research has mainly focused on identifying potential negative implications (Ryan, Marsh, Testa, & Louderman, 2006; Choi & Ryan, 2007; Grella, Needell, Shi, & Hser, 2009; de Bernabe et al., 2004). The initial sample included 178 total participants recruited from a high-risk pregnancy clinic during their pregnancy. Borderline features, approximation of borderline personality disorder (BPD) diagnosis (determined using a cutoff score of self-reported features, Kurt & Morey, 2001), opioid use status in pregnancy, and postpartum opioid use status were evaluated as potential predictors of maternal self-efficacy (MSE), or how confident an individual feels in her role as a mother (Coleman & Karraker, 1997). MSE not only provides valuable information regarding individuals’ experience of motherhood but is also potentially modifiable through intervention and is related to parenting success (Wittkowski, Dowling, & Smith, 2016; Albanese, Russo, & Geller, 2019). Given that individuals with BPD and those that use opioids are disproportionately likely to have experienced adverse childhood experiences (ACEs) and because ACEs are negatively associated with MSE (Gannon, Short, LaNoue, Abatemarco, 2021; Treat, Sheffield-Morris, Williamson & Hays-Grudo, 2020), we postulated that borderline features, BPD diagnosis approximation, opioid use during pregnancy, and postpartum opioid use would each individually inversely predict MSE. Additionally, we hypothesized that borderline features and BPD diagnosis approximation would function as moderators of the relationship between opioid use status (during pregnancy and postpartum, respectively) and MSE. However, the study hypotheses were not supported. Of note, the current study included a relatively small sample size and a very high attrition rate (only 54 participants completed follow-up assessments, 30.34% of initial sample) which limited statistical power in the study. Future research with greater resources to increase sample size and reduce attrition (through increased staffing and participant reimbursement) should reevaluate these hypotheses. Additionally, future research should broadly focus on extending the goal of understanding the experiences of individuals using opioids in pregnancy in a manner that honors the complexities and nuances involved in this use while also examining external situational influences that may be at play.