JMIR Publications

ABSTRACT

Background:

Substance use during the perinatal period is a growing global public health concern, associated with significant risks for maternal health, child development, and parenting. Despite these risks, the perinatal period is often described as a “window of opportunity” for behavioral change and the initiation of recovery. However, research exploring how vulnerability and transformation interact in the context of perinatal substance use remains scarce. Existing studies are predominantly cross-sectional, deficit-oriented, and focused on relapse or medical effects of prenatal substance use exposure, leaving critical gaps in understanding maternal trajectories and the psychosocial factors shaping the transition to parenthood.

Objective:

The PIPPA (Perinatal Insights into Parenting, Pathways, and Addiction) study addresses these gaps by adopting a strength-based, exploratory approach. It aims to examine how maternal, psychosocial, and contextual factors influence whether the perinatal period represents an (un)promising transition to parenthood for women with substance use disorders (SUD), and how maternal and child trajectories unfold over time.

Methods:

PIPPA is a longitudinal, prospective, multicentre mixed-methods study conducted in Flanders, Belgium (May 2025–November 2026). Fifty (pregnant) mothers with alcohol and/or other substance use problems are recruited through obstetric departments, general substance use services, specialized substance use services for (expecting) parents, child protection services, and social media. Participants are assessed at two or three time points: during pregnancy, 2–6 weeks postpartum, and six months postpartum. Data collection combines quantitative and qualitative measures: validated questionnaires (AUDIT-C, DUDIT-C, EPDS, SWLS, BARC-10, MAAS, MPAS, Parental Stress Scale), custom instruments capturing sociodemographic and contextual factors, and speech tasks (Three-Minute and Five-Minute Speech Samples) to assess maternal representations and parent–child relationship quality. Semi-structured interviews with mothers and involved caregivers complement these assessments. All data are securely managed in REDCap. Quantitative analyses will include descriptive, longitudinal, subgroup, and regression models; qualitative data will be analyzed using longitudinal thematic analysis and structured coding of expressed emotion.

Results:

Recruitment began in May 2025, and data collection began in June 2025. Completion is expected by November 2026, when all infants reach six months of age. Data analysis will be performed after full data collection.

Conclusions:

This research seeks to contribute to a more strengths-based and evidence-based understanding of the transition to motherhood in the context of perinatal substance use. By integrating maternal narratives, psychosocial dynamics, and contextual influences, PIPPA will provide nuanced insights into the complex interplay between substance use, recovery, and parenting. Findings will inform integrated care models and early interventions aimed at supporting mothers with SUD and safeguarding child well-being.