(10) Exploring Unintended Pregnancy Among Patients with Opioid Use Disorder

Background and

Introduction:
The opioid epidemic has greatly impacted Maine with over 2700 people dying due to opioid overdose between 2010-2019. Prevalence of maternal Opioid Use Disorder (OUD) and Neonatal Opioid Withdrawal Syndrome (NOWS) in Maine is among the highest in the United States. In 2018, Neonatal Opioid Withdrawal Syndrome was reported to be  31.4 per 1000 , and maternal OUD 37.8 per 1000 in our state. One study showed that opioid use in the month before conception led to a nearly 3-fold greater risk of poorly timed or unplanned pregnancy compared to no opioid use.
The clinical community at Maine-Dartmouth Family Medicine Residency noted similar trends in pregnancy planning among our patient population. Our study aims to better delineate the impact of OUD in this population to eventually inform interventions that could increase access to health services and ultimately improve maternal, fetal, and newborn health.
We hypothesized that among reproductive-age birthing patients of two Central Maine family practices, those with a diagnosis of OUD experience a higher prevalence of unplanned pregnancy than those without this diagnosis.

Methods:
We designed a retrospective observational cohort study of pregnant patients of two family medicine practices between the ages of 18 and 40, with collection of the following data over a two year period:
1) Method of pregnancy diagnosis, 2) Gravity and parity, 3) ICD-9/10 codes related to pregnancy and substance use, and mental health diagnoses, 4) Health insurance, 5) Medication for Opioid Use Disorder (MOUD) prescriptions and dosing, and 6) Pregnancy outcome.
Two chart reviews were performed on each pregnancy with initial reviews performed by family medicine residents, medical students, and undergraduate students, and second reviews performed by senior family medicine residents and the principal investigator (faculty physician).
The study is ongoing, with a total of 1188 eligible pregnancies identified currently. 915 initial chart reviews and 321 second chart reviews have been completed to date. To obtain preliminary data, chi-square analysis was performed on a random sample of 250 pregnancies from charts that had been reviewed twice. We plan chi-square analysis on the full data set once the data collection is complete. Our preliminary results are based on a partial data set, using a random sample of 250 pregnancies that had undergone two chart reviews.

Results:
Several findings were interesting. There was a significantly higher proportion of pregnancies among those with OUD were unplanned than among those without OUD (55.1% vs. 36.3%, p< 0.002), and among pregnant patients with OUD, those who were not receiving medication for OUD were significantly more likely to have an unplanned pregnancy (64.7% vs. 45.7%, p< 0.02). Additionally, there appears to be a higher proportion of anxiety (61% vs. 39%) among pregnant patients with OUD vs. those without OUD, and both tobacco use and depression appear to be more common among pregnant patients with OUD compared to those without OUD.

Conclusion &

Discussion:
There appears to be a strong relationship between Opioid Use Disorder (OUD) and unplanned pregnancy in our population, as well as a higher number of patients with co-morbid anxiety, depression and tobacco use in pregnancies affected by OUD compared to those without OUD. Lower prevalence of unplanned pregnancy in pregnant people using MOUD suggests that people with OUD may benefit from a more integrated approach to health care including contraception access.
Limitations: This study is a work in progress, and current findings are limited by performing the analysis on only a partial data set.

References:
1.Governor’s Office of Policy Innovation and the Future. (2021, January). Maine opioid response: 2021 strategic action plan. https://mainedrugdata.org/. https://www.mainedrugdata.org/wp-content/uploads/2021/02/Strategic-Action-Plan-2021.Full-Plan.1.31.21-FINAL.pdf

2.Hirai A. H., Ko J. Y., Owens P. L., Stocks C., Patrick S. W. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA 2021; 325(2):146. https://doi.org/10.1001/jama.2020.24991      

3.Gabrielson S. M. B, Carwile J. L, O’Connor A, Ahrens K. A. Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009–2018. Public Health. 2020;181:171-179. doi:10.1016/j.puhe.2019.12.014

4. Lundsberg LS, Peglow S, Qasba N, Yonkers KA, Gariepy AM. Is preconception substance use associate with unplanned or poorly timed pregnancy? J Addict Med 2018; 12(4): 321-328.

5. Chou , J. L., Patton , R., Cooper-Sadlo , S., Swan , C., Bennett , D. S., McDowell , D., Zaarur , A., & Schindler , B. (2022). Stigma and medication for opioid use disorder (MOUD) among women. International Journal of Mental Health and Addiction, 20, 3262–3273..