Models of perinatal care for women using drugs and their infants. synopsis of The Stepping Stones Study

TY - JOUR

T1 - Models of perinatal care for women using drugs and their infants.

T2 - synopsis of The Stepping Stones Study

AU - Radcliffe, Polly

AU - Featherstone, Brid

AU - Aladangady, Narendra

AU - Maxwell, Margaret

AU - Neale, Joanne

AU - Gilmour, Lynne

AU - Honeybul, Louise

AU - Lewis, Shirley

AU - Smith, Emma

AU - Utrilla, Mariana Gonzalez

AU - Cheyne, Helen

N1 - Publisher Copyright: © 2026 Radcliffe et al.

PY - 2026/1/14

Y1 - 2026/1/14

N2 - Background: Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom’s guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: 1. A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. 2. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services’ involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population. Limitations: For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal study took part in all the anticipated interviews. Future research: There is a need for high-quality research studies into effective interventions for pregnant women who use drugs. Implementation research is required to test and implement the theory of change for optimum services for women who use drugs in the perinatal period.

AB - Background: Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom’s guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: 1. A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. 2. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services’ involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population. Limitations: For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal study took part in all the anticipated interviews. Future research: There is a need for high-quality research studies into effective interventions for pregnant women who use drugs. Implementation research is required to test and implement the theory of change for optimum services for women who use drugs in the perinatal period.

KW - Female

KW - Humans

KW - Pregnancy

KW - United Kingdom

KW - Perinatal Care/organization & administration

KW - Qualitative Research

KW - Substance-Related Disorders/therapy

KW - Infant, Newborn

KW - Pregnancy Complications

KW - Adult

KW - Infant

KW - Longitudinal Studies

UR - https://www.scopus.com/pages/publications/105028138416

U2 - 10.3310/GJPR0411

DO - 10.3310/GJPR0411

M3 - Article

C2 - 41560302

SN - 2755-0060

VL - 14

SP - 1

EP - 36

JO - Health and social care delivery research

JF - Health and social care delivery research

IS - 2

ER -