{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T03:46:07Z","timestamp":1772941567587,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,4]]},"group-title":"Addiction Medicine","reference-count":44,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Maternal mental health conditions, comprising maternal suicide and drug overdose, are currently the leading cause of maternal mortality in the United States. However, the relationship between suicidality and drug use behavior in the perinatal period is not well understood. We examined the association between suicidality and drug use behavior among perinatal individuals. Given the racial disparities in both drug use and suicide rates in the U.S., we also examined any differences in suicidality and drug use behavior by race.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants were recruited from a High-Risk Obstetric &amp; Gynecological Clinic in the Midwestern U.S that specializes in providing obstetric care to perinatal individuals who have histories or current use of opioids and other illicit drugs. Participants (N = 66) were a sub-sample of a larger cohort enrolled in an mHealth intervention to support recovery from opioid and stimulant use disorders. We performed chi-square tests and t-tests to examine any significant associations between lifetime suicidality and drug use behavior during the perinatal period.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    The final analytic sample included participants who had responded to the suicidality survey questions (n=43). Nearly 40% (n=16) of our sample endorsed a lifetime history of suicidal thoughts and behaviors (SITB). Of those, 87% (n=15) reported a previous suicide\n                    <jats:italic>attempt<\/jats:italic>\n                    . SITB was significantly associated with cravings for opioids during the perinatal period (p = .01) as well as comorbidities with perinatal anxiety symptoms? ( p &lt; .05), depression symptoms? (p &lt; .05), and bipolar disorder (p &lt; .05). A higher proportion of recent cannabis use was found among mothers with SITB, compared to those without SITB (p=0.04). Mothers with SITB also had a strong positive correlation between preconception and postnatal nicotine use compared to mothers without SITB (p &lt; .01). Finally, while white mothers endorsed more lifetime overdoses (p= 0.01), Black mothers endorsed higher cravings for opioids during pregnancy (p = 0.03).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A history of SITB is a distinct risk factor for both illicit and recreational drug use behavior in the perinatal period, and frequently co-occurs with other perinatal mental health conditions. Further research is needed to better understand the directionality of this relationship and the complex interplay between high risk drug use behavior and suicidality.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.03.26347368","type":"posted-content","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T03:20:15Z","timestamp":1772680815000},"source":"Crossref","is-referenced-by-count":0,"title":["Suicidality and Drug Use Behavior Among Perinatal Individuals in Recovery"],"prefix":"10.64898","author":[{"given":"Anna","family":"Constantino-Pettit","sequence":"first","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Li","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Szlyk","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Kasson","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Cavazos-Rehg","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026030703050606000_2026.03.03.26347368v1.1","first-page":"1","article-title":"Psychiatric co-morbidities in pregnant women with opioid use disorders: prevalence, impact, and implications for treatment","volume":"4","year":"2017","journal-title":"Current addiction reports"},{"key":"2026030703050606000_2026.03.03.26347368v1.2","first-page":"1","article-title":"Psychiatric co-morbidities in pregnant women with opioid use disorders: prevalence, impact, and implications for treatment","volume":"4","year":"2017","journal-title":"Current addiction reports"},{"key":"2026030703050606000_2026.03.03.26347368v1.3","doi-asserted-by":"crossref","first-page":"109868","DOI":"10.1016\/j.drugalcdep.2023.109868","article-title":"Duration of medication for opioid use disorder during pregnancy and postpartum by race\/ethnicity: Results from 6 state Medicaid programs","volume":"247","year":"2023","journal-title":"Drug and Alcohol Dependence"},{"issue":"4","key":"2026030703050606000_2026.03.03.26347368v1.4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0740-5472(99)00084-7","article-title":"Depression among needle exchange program and methadone maintenance clients","volume":"18","year":"2000","journal-title":"J Subst Abus Treat"},{"key":"2026030703050606000_2026.03.03.26347368v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(00)00148-4"},{"issue":"1","key":"2026030703050606000_2026.03.03.26347368v1.6","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/pubmed\/fdy207","article-title":"Delivering information about medication assisted treatment to individuals who misuse opioids through a mobile app: a pilot study","volume":"42","year":"2020","journal-title":"Journal of Public Health"},{"key":"2026030703050606000_2026.03.03.26347368v1.7","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.b.32880"},{"key":"2026030703050606000_2026.03.03.26347368v1.8","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.150.6.782"},{"key":"2026030703050606000_2026.03.03.26347368v1.9","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721004256"},{"issue":"12","key":"2026030703050606000_2026.03.03.26347368v1.10","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1097\/CHI.0b013e3181bfa8ee","article-title":"Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study","volume":"48","year":"2009","journal-title":"Journal of the American Academy of Child & Adolescent Psychiatry"},{"issue":"6","key":"2026030703050606000_2026.03.03.26347368v1.11","first-page":"6","article-title":"\u201cA Closer Look at Substance Use and Suicide.\u201d American Journal of Psychiatry Residents\u2019","volume":"13","year":"2018","journal-title":"Journal"},{"key":"2026030703050606000_2026.03.03.26347368v1.12","doi-asserted-by":"publisher","DOI":"10.2307\/2340521"},{"issue":"6","key":"2026030703050606000_2026.03.03.26347368v1.13","doi-asserted-by":"crossref","first-page":"e356","DOI":"10.1097\/ADM.0000000000000979","article-title":"Explaining racial-ethnic disparities in the receipt of medication for opioid use disorder during pregnancy","volume":"16","year":"2022","journal-title":"Journal of addiction medicine"},{"key":"2026030703050606000_2026.03.03.26347368v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2011.09.017"},{"key":"2026030703050606000_2026.03.03.26347368v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.05.045"},{"key":"2026030703050606000_2026.03.03.26347368v1.16","unstructured":"https:\/\/afsp.org\/suicide-statistics\/ https:\/\/store.samhsa.gov\/sites\/default\/files\/d7\/priv\/sma18-5054.pdf https:\/\/www.cdc.gov\/reproductivehealth\/maternal-mortality\/erase-mm\/data-mmrc.html https:\/\/www.cdc.gov\/reproductivehealth\/maternal-mortality\/pregnancy-mortality-surveillance-system.htm https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/4622"},{"issue":"3","key":"2026030703050606000_2026.03.03.26347368v1.17","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S2215-0366(16)00003-1","article-title":"Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry","volume":"3","year":"2016","journal-title":"The Lancet Psychiatry"},{"issue":"32","key":"2026030703050606000_2026.03.03.26347368v1.18","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.15585\/mmwr.mm6932a2","article-title":"Characteristics of marijuana use during pregnancy\u2014eight states, pregnancy risk assessment monitoring system, 2017","volume":"69","year":"2020","journal-title":"Morbidity and mortality weekly report"},{"key":"2026030703050606000_2026.03.03.26347368v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.conb.2013.03.011"},{"key":"2026030703050606000_2026.03.03.26347368v1.20","doi-asserted-by":"publisher","DOI":"10.1111\/add.15582"},{"issue":"36","key":"2026030703050606000_2026.03.03.26347368v1.21","doi-asserted-by":"crossref","first-page":"777","DOI":"10.15585\/mmwr.mm6836a1","article-title":"State strategies to address opioid use disorder among pregnant and postpartum women and infants prenatally exposed to substances, including infants with neonatal abstinence syndrome","volume":"68","year":"2019","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"2026030703050606000_2026.03.03.26347368v1.22","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.133553"},{"key":"2026030703050606000_2026.03.03.26347368v1.23","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004649"},{"issue":"2","key":"2026030703050606000_2026.03.03.26347368v1.24","first-page":"183","article-title":"Urban-rural differences in pregnancy-related deaths, United States, 2011\u20132016","volume":"225","year":"2021","journal-title":"American journal of obstetrics and gynecology"},{"issue":"6","key":"2026030703050606000_2026.03.03.26347368v1.25","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1097\/AOG.0000000000001695","article-title":"Maternal deaths from suicide and overdose in Colorado, 2004\u20132012","volume":"128","year":"2016","journal-title":"Obstetrics and gynecology"},{"key":"2026030703050606000_2026.03.03.26347368v1.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101696"},{"issue":"6","key":"2026030703050606000_2026.03.03.26347368v1.27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1176\/appi.ajp.22020102","article-title":"Opioid prescribing and suicide risk in the United States","volume":"180","year":"2023","journal-title":"American journal of psychiatry"},{"key":"2026030703050606000_2026.03.03.26347368v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.09.008"},{"issue":"18","key":"2026030703050606000_2026.03.03.26347368v1.29","first-page":"423","article-title":"Vital signs: pregnancy-related deaths, United States, 2011\u20132015, and strategies for prevention, 13 states, 2013\u20132017","volume":"68","year":"2019","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"2026030703050606000_2026.03.03.26347368v1.30","first-page":"4","article-title":"Opioid use disorder and perinatal outcomes","volume":"148","year":"2021","journal-title":"Pediatrics"},{"key":"2026030703050606000_2026.03.03.26347368v1.31","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.765118"},{"key":"2026030703050606000_2026.03.03.26347368v1.32","doi-asserted-by":"publisher","DOI":"10.1007\/s40429-021-00361-z"},{"key":"2026030703050606000_2026.03.03.26347368v1.33","unstructured":"Roberts, D. E . (2022). Torn apart: how the child welfare system destroys Black families\u2014and how abolition can build a safer world (First edition.). Basic Books."},{"key":"2026030703050606000_2026.03.03.26347368v1.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.101978"},{"key":"2026030703050606000_2026.03.03.26347368v1.35","doi-asserted-by":"crossref","first-page":"108454","DOI":"10.1016\/j.jsat.2021.108454","article-title":"Racial inequity in methadone dose at delivery in pregnant women with opioid use disorder","volume":"131","year":"2021","journal-title":"Journal of Substance Abuse Treatment"},{"key":"2026030703050606000_2026.03.03.26347368v1.36","doi-asserted-by":"publisher","DOI":"10.1521\/suli.2010.40.4.416"},{"key":"2026030703050606000_2026.03.03.26347368v1.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.04.210"},{"issue":"5","key":"2026030703050606000_2026.03.03.26347368v1.38","doi-asserted-by":"crossref","first-page":"e205734","DOI":"10.1001\/jamanetworkopen.2020.5734","article-title":"Assessment of racial and ethnic disparities in the use of medication to treat opioid use disorder among pregnant women in Massachusetts","volume":"3","year":"2020","journal-title":"JAMA Network Open"},{"key":"2026030703050606000_2026.03.03.26347368v1.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2013.10.019"},{"key":"2026030703050606000_2026.03.03.26347368v1.40","doi-asserted-by":"crossref","unstructured":"Shen, Y. , Lo-Ciganic, W. H. , Segal, R. , & Goodin, A. J . (2020). Prevalence of substance use disorder and psychiatric comorbidity burden among pregnant women with opioid use disorder in a large administrative database, 2009\u20132014. Journal of Psychosomatic Obstetrics & Gynecology, 1\u20137.","DOI":"10.1080\/0167482X.2020.1727882"},{"key":"2026030703050606000_2026.03.03.26347368v1.41","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2026030703050606000_2026.03.03.26347368v1.42","first-page":"2022","article-title":"Racial differences in immediate postpartum depression and suicidal ideation among women in a Midwestern Delivery Hospital","volume":"12","year":"2020","journal-title":"Journal of Affective Disorders Reports. Retrieved August"},{"key":"2026030703050606000_2026.03.03.26347368v1.43","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-019-1040-1"},{"key":"2026030703050606000_2026.03.03.26347368v1.44","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.00615"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.03.03.26347368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T11:05:19Z","timestamp":1772881519000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.03.03.26347368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":44,"URL":"https:\/\/doi.org\/10.64898\/2026.03.03.26347368","relation":{},"subject":[],"published":{"date-parts":[[2026,3,4]]},"subtype":"preprint"}}