Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder

Kotha, Anupama; Chen, Beatrice A.; Lewis, Lauren; Dunn, Shannon; Himes, Katherine P.

doi:10.1016/j.contraception.2018.08.008

Cited by 25 publications

(21 citation statements)

References 22 publications

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“…29 In fact, one institution that did not previously offer immediate postpartum LARC insertion noted that while there is interest and intent in LARC use in women with OUD, many women did not receive them in the interval period. 24 We also found that older women more often chose tier 1 contraceptive methods. This is likely due to the choice of sterilization in women who have satisfied parity.…”

Section: Discussionmentioning

confidence: 60%

“…22 This is in contrast to 14% LARC use rates reported in the general population. 23 Low uptake of contraception in opioid using women has been attributed to numerous factors, including poor postpartum visit attendance, 3,24,25 stigma and fear of losing custody of their child(ren), 26 lack of information regarding both LARCs and short-acting methods, 27 and misunderstanding of their fertility. 3,28 Interestingly, we also found that more than half of women with self-reported opioid use in our study chose immediate tier 1 method uptake, of which Data are represented as n (%), unless noted as means in which case it is meanstandard deviation.…”

Section: Discussionmentioning

confidence: 99%

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Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

Radwan

Ray

Haas

2020

Women's Health Reports

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The aim of this study was to examine whether a history of opioid use predicts tier 1 contraceptive use or plan to use in women with infants in the neonatal intensive care unit (NICU) and nursery. Materials and Methods: We conducted a self-administered, anonymous survey in women with infants in three local NICUs and two postpartum units from November 2018 to May 2019. Women were recruited while visiting their infants in the NICU or in their postpartum rooms. Our survey included adapted questions from the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire, the National Institute of Drug Abuse (NIDA) Modified ASSIST Screening Tool, and ones written by our team. The questions asked about contraceptive use and opioid use. We compared the responses of women with and without a history of opioid use. We conducted a multivariable regression analysis and applied the backward elimination method to identify whether opioid use was a predictor of tier 1 contraceptive use or plan to use. Results: A total of 122 women completed the survey. Fifty-three women (43.4%) reported opioid use in the month before pregnancy and/or during pregnancy, while 69 (56.6%) women reported no opioid use and comprised the control group. Multivariable regression analysis showed that opioid use was not associated with the use or planned use of tier 1 contraceptives (adjusted odds ratio [aOR] 1.47; confidence interval [95% CI] 0.54-4.01). Older maternal age predicted tier 1 choice (aOR 1.12; 95% CI 1.04-1.21), while African American women were less likely to use or plan to use tier 1 contraceptives compared with white women (aOR 0.21; 95% CI 0.08-0.56). Conclusion: A history of opioid use was not independently associated with women using or planning to use tier 1 methods, while age and race were predictors.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

Radwan

Ray

Haas

2020

Women's Health Reports

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“…41 Intent to initiate these methods is dependent on antepartum contraception discussions. 42 For all these reasons, antepartum contraception counseling is vital to postpartum contraceptive usage. [15][16][17][18][19][20][21][22][23] While this study captures a large sample size of diverse women including both high-and low-risk women, there are some limitations.…”

Section: Discussionmentioning

confidence: 99%

Antepartum Contraceptive Counseling in Women with Preterm Birth

Toscano

Dye

et al. 2019

Amer J Perinatol

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Objective To compare rates of antepartum contraceptive counseling among women with preterm birth (PTB) and term birth. Study Design This is a retrospective cohort study of patients with completed delivery records in New York from January 1, 2004, to December 31, 2014. Exposure was determined based on the timing of delivery. Exposed women delivered at <37 weeks, and nonexposed women delivered at ≥37 weeks. Primary outcome was patient response to questions regarding receipt of prenatal contraceptive counseling (PCC) by a health care provider. Secondary outcome was receipt of interpregnancy interval counseling. Chi-square tests and multivariate logistic regression were used for analysis. Results Of 724,723 delivery records, PTB rate was 7.9%. Women with PTB < 37 weeks were significantly less likely to receive PCC (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.89–0.93) or interpregnancy interval counseling (OR: 0.95; 95% CI: 0.94–0.97). The primary outcome remained significant after adjusting for confounders (adjusted OR: 0.91; 95% CI: 0.89–0.93). PTB < 34 weeks was associated with even lower odds of receiving contraceptive counseling (OR: 0.79; 95% CI: 0.76–0.83). Conclusion Postpartum contraception is an important tool for the prevention of recurrent PTB. Antepartum contraception counseling increases postpartum contraceptive uptake. Women with PTB have less exposure to antepartum contraceptive counseling. Lack of adequate counseling and decreased uptake of postpartum contraception may impact future pregnancy outcomes.

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“…39 For example, one retrospective study of pregnant women with opioid use disorder receiving MAT (n = 791) found that approximately one-third of women (35%) intended to use postpartum LARC, but of those, only 45% of women attended the postpartum visit and <20% received the contraceptive. 40 This is not unique to women who use opioids, as ≈ 10% to 40% of all women do not attend the postpartum visit, and 40% to 75% of women who plan to use a postpartum IUD do not obtain it. [41][42][43] However, the American Congress of Obstetricians and Gynecologists recommends immediate postpartum LARC as a contraceptive option for all women, particularly women who use opioids, due to a lower rate of contraceptive use and higher rate of unplanned pregnancies than women who do not use opioids.…”

Section: Costmentioning

confidence: 99%

“…Women may avoid accessing medical care or family planning services outside of their substance use disorder treatment facility because of logistical challenges such as lag times in getting an appointment and difficulties in attending referral appointments 39 . For example, one retrospective study of pregnant women with opioid use disorder receiving MAT (n = 791) found that approximately one‐third of women (35%) intended to use postpartum LARC, but of those, only 45% of women attended the postpartum visit and <20% received the contraceptive 40 . This is not unique to women who use opioids, as ≈ 10% to 40% of all women do not attend the postpartum visit, and 40% to 75% of women who plan to use a postpartum IUD do not obtain it 41–43 .…”

Section: Factors Affecting Contraceptive Accessmentioning

confidence: 99%

Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder

Stone

Griffin

Fusco

et al. 2020

The Journal of Clinical Pharma

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Maternal opioid use disorder increased > 4‐fold from 1999 to 2014 and is associated with poor maternal and fetal outcomes. Women with opioid use disorder are at 2 to 3 times greater risk for unintended pregnancy than the general population and may face additional barriers to accessing and effectively using contraception compared to women without opioid use disorder, particularly highly effective long‐acting reversible contraception. Additionally, women with opioid use disorder tend to use less effective forms of contraception such as condoms alone. Barriers to contraceptive access include patient misconceptions or knowledge gaps regarding reproductive health and family planning, cost, intimate partner violence, fear of criminalization, difficulty accessing care, comorbid health conditions, and health care provider misconceptions or practice limitations. Strategies that may assist women with opioid use disorder in achieving their family planning goals include colocation of family planning services within opioid treatment facilities, optimization of patient care services to minimize the need for costly and/or time consuming follow‐up, increasing provider education and awareness of best practices in family planning and opioid use disorder treatment, and providing patient‐centered family planning education and counseling. Additional research is needed to identify and develop strategies that empower women who use opioids to effectively access and use their preferred contraceptive method.

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Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder

Abstract: Despite prenatal interest in using LARC, most pregnant women with OUD on MAT did not receive postpartum LARC. The provision of immediate postpartum LARC services may reduce barriers to postpartum LARC receipt such as poor attendance at the postpartum visit.

Cited by 25 publications

References 22 publications

Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

Antepartum Contraceptive Counseling in Women with Preterm Birth

Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder

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