(13) Contraceptive Uptake in Postpartum People with and without Opioid Use Disorder

Background & Introduction: Opioid use during pregnancy is associated with significant maternal morbidity and mortality (1,2). Initiation of contraception in the postpartum period can help people with opioid use disorder (OUD) enter a subsequent pregnancy when they are ready. While people with OUD are less likely to use contraception and more likely to use less effective methods than people without OUD (3), whether initiation of postpartum contraception differs among people with and without OUD is not well studied.

Methods: Analyses used 73,811 pregnancy episodes among 61,221 people (2016-2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. OUD with co-occurring substance use was defined as OUD plus one or more diagnoses of alcohol, stimulant, sedative, or cannabis use disorder. Contraceptive uptake was defined within 90-days after delivery. Generalized Estimating Equations (GEE) type robust Poisson modeling assessed the association of OUD with and without co-occurring SUD with initiation of any contraception and by type of contraception (none vs. effective – user, dependent hormonal methods vs. highly effective – long-acting reversible (LARC) methods and sterilization).

Results: The sample was 66.0% white and average age was 27.7 years (±5.6). About one-third (32.5%) of pregnancies were followed by contraception initiation within 90 days of delivery. 2.3% of the sample had an associated OUD diagnosis while 9.4% had any substance use diagnosis. In fully adjusted models, OUD was unrelated to starting any contraception. However, people with OUD were less likely to receive highly effective methods (aRR=0.84; 95% CI: 0.74-0.96). In fully adjusted models, people with OUD plus co-occurring SUD were less likely to start any contraception in the 90 days after delivery (aRR=0.87; 0.79-0.96) in addition to highly effective methods compared to people with no SUD (aRR=0.60; 0.50-0.73).

Conclusion & Discussion: Postpartum people with OUD vs. no OUD were significantly less likely to start a long-acting highly effective method than a user-dependent method. People with OUD plus co-occurring SUD were even less likely to start a highly effective method within 90 days after delivery. The reasons people choose contraceptive methods are complex, and not solely based on method effectiveness. Due to the increased risk of maternal morbidity and mortality among women with OUD that is compounded by using additional substances, the need to utilize patient-centered approaches that take into account people’s pregnancy wishes is desperately needed to help people with OUD enter pregnancy when they are ready and improve the health of their children and families. More research is needed to understand the complex factors that impact decision making around postpartum contraception initiation among people with OUD with and without co-occurring SUD that maintains patient autonomy and reduces stigma.

References: 1. Maeda, A., Bateman, B. T., Clancy, C. R., Creanga, A. A., & Leffert, L. R. (2014). Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology, 121(6), 1158-1165. https://doi.org/10.1097/ALN.0000000000000472
2. Gemmill, A., Kiang, M. V., & Alexander, M. J. (2019). Trends in pregnancy-associated mortality involving opioids in the United States, 2007-2016. Am J Obstet Gynecol, 220(1), 115-116. https://doi.org/10.1016/j.ajog.2018.09.028
3. Terplan, M., Hand, D. J., Hutchinson, M., Salisbury-Afshar, E., & Heil, S. H. (2015). Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review. Prev Med, 80, 23-31. https://doi.org/10.1016/j.ypmed.2015.04.008