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Hensel D, Helou NE, Zhang F, Stout MJ, Raghuraman N, Friedman H, Carter E, Odibo AO, Kelly JC. The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care. Am J Perinatol 2024; 41:884-890. [PMID: 35668653 DOI: 10.1055/s-0042-1748526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. STUDY DESIGN This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic-Clinic for Acceptance Recovery and Empowerment (CARE)-between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. RESULTS A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05-1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76-1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36-1.84). CONCLUSION In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. KEY POINTS · Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic..
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Affiliation(s)
- Drew Hensel
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nicole El Helou
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Fan Zhang
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony Carter
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Anthony O Odibo
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeannie C Kelly
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Malhotra T, Thomas K, Ngendahimana D, Gibson KS, Arora KS. Consistency of antenatal contraceptive plan and postpartum fulfillment in patients with opioid use disorder. Arch Womens Ment Health 2024; 27:153-155. [PMID: 37923931 PMCID: PMC10872718 DOI: 10.1007/s00737-023-01388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Tani Malhotra
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kathryn Thomas
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - David Ngendahimana
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, California, USA
| | - Kelly S Gibson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA.
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Thomas KN, Malhotra T, Ngendahimana D, Gibson KS, Arora KS. Postpartum contraceptive choice and fulfillment in patients with opioid use disorder. Contraception 2023; 128:110267. [PMID: 37633590 PMCID: PMC10873085 DOI: 10.1016/j.contraception.2023.110267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE We examined the differences in postpartum contraception between patients with and without opioid use disorder (OUD). STUDY DESIGN We conducted a retrospective, single-institution, cohort analysis assessing differences in desired method of postpartum contraception and plan fulfillment. RESULTS Patients with OUD comprised 200/8654 (2.3%) of our study cohort. After 2:1 matching, method desired (matched odds ratio [mOR] 0.86, 95% confidence interval [CI] 0.60-1.23 for highly vs. moderately effective) and receipt (mOR 0.77, 95% CI 0.53-1.12) of desired method were comparable between groups. CONCLUSION Patients with and without OUD were similar in their choice and fulfillment of postpartum contraception.
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Affiliation(s)
- Kathryn N Thomas
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - Tani Malhotra
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA; Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Ngendahimana
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, USA
| | - Kelly S Gibson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Kavita S Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
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Malhotra T, Sheyn D, Arora K. Association of Opioid Use Disorder and Provision of Highly Effective Inpatient Postpartum Contraception. Open Access J Contracept 2023; 14:95-102. [PMID: 37362953 PMCID: PMC10290468 DOI: 10.2147/oajc.s411092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
We sought to examine the rates of the inpatient provision of postpartum long-acting and permanent methods (IPP LAPM) of contraception in patients with opioid use disorder (OUD). This is a retrospective cross-sectional regression analysis of the National Inpatient Sample between 2012 and 2016. Patients with a diagnosis of OUD that delivered and received postpartum permanent contraception or long acting reversible contraception placement during the same hospitalization were identified. Regression analyses were performed to identify the demographic and clinical factors associated with long acting and permanent contraception method utilization. Of the 22,294 patients with OUD who delivered during the study period, 2291 (10.3%) received IPP LAPM. The majority of patients (1989) (86.6%) with OUD who chose inpatient provision of long acting or permanent methods after delivery received permanent contraception. After adjusting for covariates, patients with OUD had an overall decreased probability of receiving IPP LAPM (aOR=0.89, 95% CI: 0.85-0.95), decreased probability of receiving permanent contraception (aOR: 0.82, 95% CI: 0.78-0.88), but an increased probability of receiving long-acting reversible contraception (aOR: 1.29, 95% CI: 1.04-1.60) compared to patients without OUD. This study highlights the continued need to ensure appropriate measures (such as antepartum contraceptive counseling, availability of access to inpatient LAPM, and removal of Medicaid policy barriers to permanent contraception) are in place so that the contraceptive needs of patients with OUD are fulfilled.
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Affiliation(s)
- Tani Malhotra
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Sheyn
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kavita Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
- Department of Obstetrics and Gynecology, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA
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Hussaini K, Yocher G. Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018. Dela J Public Health 2023; 9:134-140. [PMID: 37622155 PMCID: PMC10445619 DOI: 10.32481/djph.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Objective Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant. Study Design Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance. Results Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant. Conclusions Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.
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Affiliation(s)
- Khaleel Hussaini
- Division of Public Health, Delaware Department of Health and Social Services; Division of Reproductive Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
| | - George Yocher
- Division of Public Health, Delaware Department of Health and Social Services
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Krans EE, Chen BA, Rothenberger SD, Bogen DL, Jones K, Turocy MJ, Klocke LC, Schwarz EB. Increasing access to immediate postpartum contraceptive implants: a prospective clinical trial among patients with opioid use disorder. EUR J CONTRACEP REPR 2022; 27:478-485. [PMID: 36062524 PMCID: PMC9795857 DOI: 10.1080/13625187.2022.2114791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/30/2022] [Accepted: 08/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the effects of increased access to immediate postpartum contraceptive implants (IPI) on repeat pregnancy and contraceptive use rates among patients with opioid use disorder (OUD). MATERIALS AND METHODS Between 2016 and 2018, 194 postpartum patients with OUD were offered the option of IPI placement at an institution with limited immediate postpartum long-acting reversible contraception availability and followed for one-year postpartum. Differences in pregnancy rates between participants who did and did not choose IPI were examined using logistic regression with inverse probability of treatment weighting from propensity scores accounting for differences between the two groups. RESULTS Among 194 participants, 96 (49.5%) chose an IPI and 98 (50.5%) chose an alternative method or no contraception (non-IPI). Among IPI participants, 76 (80.9%) continued to use their implant at one-year postpartum. Overall, 19 participants had a repeat pregnancy and 11 (57.9%) were unintended. In multivariable analyses, repeat pregnancy was more likely among those who did not choose IPI (OR 9.90; 95% CI 3.58-27.03) than those who did. Participants with OUD and who used alcohol (11.66; 1.38, 98.20) or cocaine (2.72; 1.23, 5.99) during pregnancy were more likely to choose IPI. Participants who were married (0.28; 0.09, 0.89), engaged in OUD treatment prior to pregnancy (0.48; 0.25, 0.93), and happier when they found out about their pregnancy (0.87; 0.77, 0.98) were less likely to choose IPI. CONCLUSION Offering patients with OUD the option of IPI is associated with high utilisation and continuation rates, and low rates of repeat pregnancy within one-year postpartum.
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Affiliation(s)
- Elizabeth E Krans
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Perinatal Addiction Research, Education and Evidence-based Solutions, Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Beatrice A Chen
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Scott D Rothenberger
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelley Jones
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Mary J Turocy
- Department of Family Medicine, Stanford University, Stanford, CA, USA
| | - Leah C Klocke
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Eleanor B Schwarz
- Center for Healthcare Policy and Research, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:184771. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts,Address correspondence to Davida M. Schiff, MD, MSc, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114. E-mail:
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Abbass N, Malhotra T, Bullington B, Arora KS. Ethical Issues in Providing and Promoting Contraception to Women with Opioid Use Disorder. THE JOURNAL OF CLINICAL ETHICS 2022; 33:112-123. [PMID: 35731815 PMCID: PMC9444340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Women with opioid use disorder (OUD) face unique challenges meeting their reproductive goals. Because the rate of unintended pregnancy in this population is almost 80 percent, there has been a push to increase the use of contraceptives among reproductive-aged women with OUD.1 The patient-level ethical issues of such initiatives, however, are often overlooked. This review discusses the ethical issues in two realms: obtaining contraception when it is desired and avoiding contraceptive coercion when contraception is not desired. It is important that access to reproductive education and care be improved to ensure autonomous decision making by women with OUD. It is also necessary to be mindful of the history of oppressive and coercive contraception and sterilization policies in the United States. These policies have left a legacy of mistrust and continue to be manifested in the form of more subtly oppressive policies in contemporary medical practice. Such policies point to the ongoing stigmatization of, and implicit biases held against, women with OUD. Based on these ethical issues, solutions are suggested at the clinical, systemic, and societal levels.
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Affiliation(s)
- Nadia Abbass
- Medical Student at Case Western University School of Medicine in Cleveland, Ohio USA.
| | - Tani Malhotra
- Assistant Professor in the Department of Reproductive Biology at Case Western Reserve University in Cleveland, Ohio USA.
| | - Brooke Bullington
- PhD Student in the Department of Epidemiology, Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill in Chapel Hill, North Carolina USA.
| | - Kavita Shah Arora
- Division Director of the Division of General Obstetrics and Gynecology and Associate Professor with Tenure at the University of North Carolina¬-Chapel Hill, in Chapel Hill, North Carolina USA.
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Cartus AR, Jarlenski MP, Himes KP, James AE, Naimi AI, Bodnar LM. Adverse Cardiovascular Events Following Severe Maternal Morbidity. Am J Epidemiol 2022; 191:126-136. [PMID: 34343230 DOI: 10.1093/aje/kwab208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Severe maternal morbidity (SMM) affects 50,000 women annually in the United States, but its consequences are not well understood. We aimed to estimate the association between SMM and risk of adverse cardiovascular events during the 2 years postpartum. We analyzed 137,140 deliveries covered by the Pennsylvania Medicaid program (2016-2018), weighted with inverse probability of censoring weights to account for nonrandom loss to follow-up. SMM was defined as any diagnosis on the Centers for Disease Control and Prevention list of SMM diagnoses and procedures and/or intensive care unit admission occurring at any point from conception through 42 days postdelivery. Outcomes included heart failure, ischemic heart disease, and stroke/transient ischemic attack up to 2 years postpartum. We used marginal standardization to estimate average treatment effects. We found that SMM was associated with increased risk of each adverse cardiovascular event across the follow-up period. Per 1,000 deliveries, relative to no SMM, SMM was associated with 12.1 (95% confidence interval (CI): 6.2, 18.0) excess cases of heart failure, 6.4 (95% CI: 1.7, 11.2) excess cases of ischemic heart disease, and 8.2 (95% CI: 3.2, 13.1) excess cases of stroke/transient ischemic attack at 26 months of follow-up. These results suggest that SMM identifies a group of women who are at high risk of adverse cardiovascular events after delivery. Women who survive SMM may benefit from more comprehensive postpartum care linked to well-woman care.
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Sobel L, Lee YW, White KO, Woodhams E, Patton E. Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts. Contraception 2021; 104:355-360. [PMID: 34118268 DOI: 10.1016/j.contraception.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. STUDY DESIGN We conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. RESULTS Participants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. CONCLUSION When choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. IMPLICATIONS Our data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.
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Affiliation(s)
- Lauren Sobel
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA.
| | - Yeon Woo Lee
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
| | | | | | - Elizabeth Patton
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
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Jones HE, Martin CE, Andringa KR, Ellerson RM, Johnson E, Hairston E, O’ Grady KE. Sex and female empowerment (SAFE): A randomized trial comparing sexual health interventions for women in treatment for opioid use disorder. Drug Alcohol Depend 2021; 221:108634. [PMID: 33676071 PMCID: PMC8048040 DOI: 10.1016/j.drugalcdep.2021.108634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unintended pregnancies are prevalent among women with opioid use disorder (OUD). The Sex and Female Empowerment (SAFE) project developed a social-cognitive, theory-driven intervention to increase acceptance of and adherence to contraceptive practices among women receiving medication for OUD (MOUD). This study evaluated the feasibility and acceptability of two SAFE interventions (Face-to-face and Computer-adapted) compared to usual care as well as their efficacy to improve contraception utilization. METHODS This pilot randomized trial enrolled 90 heterosexual, non-pregnant, reproductive-age women receiving MOUD. Participants were randomized into either a: SAFE Face-to-face intervention, SAFE Computer-adapted intervention, or usual care (UC) condition (n = 30 each) and followed for 6 months. Outcome measures included intervention completion, intervention satisfaction, attendance at a contraception consultation appointment, and long-acting reversible contraceptive (LARC) method receipt. A generalized linear model was used for inferential testing and to estimate least squares means (predicted probabilities for binary outcomes) and their standard errors. RESULTS Compared to the UC condition, both the SAFE Face-to-face and the SAFE Computer-adapted intervention had higher intervention completion [Means (Standard Errors) = 0.97 (.03) and 0.97 (.03), respectively, vs. 0.53 (.09); ps<.001], higher intervention satisfaction [Ms (SEs) = 3.7 (.11) and 3.8 (.11), respectively, vs. 3.1 (.11); ps<0.001), higher contraception consultation visit attendance [Ms(SEs) = 0.80 (.07) and 0.73 (.08) vs. 0.33 (.09); p < .001], and greater LARC receipt [Ms(SEs) = 0.77 (.08) and 0.73 (.08) vs. 0.23 (.08); p < .001). CONCLUSIONS SAFE appears feasible and efficacious for supporting women in contraception decision-making. Integrating SAFE into women's comprehensive OUD treatment services holds promise to increase contraceptive decision-making and initiation of a chosen method.
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Affiliation(s)
- Hendrée E. Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510,Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224 USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology & Institute of Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA 23298
| | - Kimberly R. Andringa
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510
| | - Rachel Middlesteadt Ellerson
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510
| | - Elisabeth Johnson
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510
| | - Essence Hairston
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510
| | - Kevin E. O’ Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD 20742
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Charron E, Rennert L, Mayo RM, Eichelberger KY, Dickes L, Truong KD. Contraceptive initiation after delivery among women with and without opioid use disorders: A retrospective cohort study in a statewide Medicaid population, 2005-2016. Drug Alcohol Depend 2021; 220:108533. [PMID: 33513446 DOI: 10.1016/j.drugalcdep.2021.108533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study examined contraceptive initiation patterns in the 12 months following childbirth among women with opioid use disorder (OUD), women with non-opioid substance use disorders (SUDs), and women without SUDs. METHODS We conducted a retrospective cohort study using claims data from South Carolina Medicaid-enrolled women aged 15-44 who had singleton live birth between January 2005 and December 2016. Study outcomes were initiation of most or moderately effective (MME) contraceptive methods. Using multivariable and propensity score-weighted logistic regression, we analyzed the relationship between OUD and contraceptive initiation within 12 months after delivery. RESULTS We identified 71,283 live birth deliveries during the study period. In multivariable analysis, women with non-opioid SUDs and women without SUDs compared to women with OUD were more likely to initiate a MME method vs a least effective method or no method by 3 months (non-opioid SUDs: odds ratio [OR] = 1.32, 95 % confidence interval [CI] = 1.14-1.52; no SUDs: OR = 1.55, 95 % CI = 1.36-1.77) and 12 months (non-opioid SUD: OR = 1.23, 95 % CI = 1.06-1.42; no SUD: OR = 1.46, 95 % CI = 1.27-1.66) after delivery. With regards to the timing of initiation, women with non-opioid SUDs and women without SUDs were more likely than women with OUD to initiate a MME method vs a least effective method or no method after the immediate postpartum period through 3 months following delivery (non-opioid SUDs: OR = 1.41, 95 % CI = 1.18-1.68; no SUDs: OR = 1.87, 95 % CI = 1.59-2.21). We detected the similar patterns in analyses that used propensity score weighting. CONCLUSION OUD was associated with decreased likelihood of initiating a MME contraceptive method within 12 months after delivery.
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Affiliation(s)
- Elizabeth Charron
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Lior Rennert
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Rachel M Mayo
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Kacey Y Eichelberger
- University of South Carolina School of Medicine Greenville/Prisma Health Upstate, 701 Grove Road, Greenville, SC 29605, USA
| | - Lori Dickes
- Department of Parks, Recreation and Tourism Management, 263 Lehotsky Hall, Clemson University, Clemson, SC 29634, USA
| | - Khoa D Truong
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
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Abstract
The increase in prescription and illicit opioid use since 2000 has become an urgent public health crisis. While the opioid epidemic spans racial, regional, and socioeconomic divides, women have surfaced as one demographic affected by opioid use and related sequelae. Certain federal and state regulations, secondary to the Child Abuse Prevention and Treatment Act, strip pregnant women with opioid use disorders of the ability to engage autonomously with their health care clinician while simultaneously impeding their ability to achieve and sustain recovery. The purpose of this article is to explore current health policy that impacts pregnant women who use opioids. Recommendations to improve care, broadly, will be highlighted to include access to contraceptive services, universal screening for perinatal substance use, and access to appropriate treatment strategies. Policy modifications to facilitate these recommendations are discussed. The Centers for Disease Control and Prevention Policy Analytical Framework was utilized to derive recommendations. The recommendations are relevant to advanced practice registered nurses and midwives who have the potential to treat substance use in women, to women's health and pediatric registered nurses, and to nursing administrators who are involved in decision-making in obstetric and pediatric settings.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, United States
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Radwan A, Ray BN, Haas DM. Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery. WOMEN'S HEALTH REPORTS 2020; 1:375-382. [PMID: 33786502 PMCID: PMC7784807 DOI: 10.1089/whr.2019.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 12/03/2022]
Abstract
Objective: 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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Affiliation(s)
- Alia Radwan
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bobbie Nicole Ray
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Yermachenko A, Massari V, Azria E, Clergue-Duval V, Thurn M, El-Khoury Lesueur F, Jauffret-Roustide M, Melchior M. Unintended pregnancy prevention in women using psychoactive substances: A systematic review. Addict Behav 2020; 107:106393. [PMID: 32200197 DOI: 10.1016/j.addbeh.2020.106393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
This systematic review seeks to evaluate the efficacy of interventions aimed at preventing unintended pregnancies in women using psychoactive substances. Seven electronic databases (Medline, EMBASE, CINAHL, Web of Science Core Collection, PsycINFO, Cochrane CENTRAL database) were searched in October 2017. Twenty-two articles met our inclusion criteria. Interventions based on behavior change theory yielded an increase in the initiation of effective contraception as compared with provision of written information materials. The effect was more pronounced when the intervention provided on-site contraceptive counseling and free access to birth control. Financial incentives also seemed to effectively increase women's contraception intake. Case management interventions including pregnant and postpartum women with heavy levels of substance use showed promising results in terms of initiation of contraception, but rates of unintended pregnancy over long-term follow-up were nevertheless elevated. Finally, some interventions integrated family planning services into specialized centers taking care of pregnant and postpartum women with substance abuse. However, most studies aimed at postpartum and post-abortion contraception used a non-comparative design and had a number of methodological flaws. The risk of bias in most studies is high. All interventions with a primary or secondary focus on the prevention of unintended pregnancy in women using psychoactive substances short-term improvements in contraception intake, but it is unclear if these effects last or have any impact on unintended pregnancy rates in the long-term.
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Affiliation(s)
- Anna Yermachenko
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Véronique Massari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Elie Azria
- Université Sorbonne Paris Cité, INSERM, UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPe research team), DHU Risks in Pregnancy, Paris, France; Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Virgile Clergue-Duval
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint-Denis, 75010 Paris, France; Université Sorbonne Paris Cité, Faculté de Médecine, Paris Diderot, Paris, France
| | - Marion Thurn
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France; Cermes 3 (Inserm U988/CNRS UMR 8211/EHESS/Université Paris Descartes), Paris, France
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | | | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France.
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Gabrielson S, Carwile J, O'Connor A, Ahrens K. 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] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022]
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Martin CE, Terplan M, Krans EE. Pain, Opioids, and Pregnancy: Historical Context and Medical Management. Clin Perinatol 2019; 46:833-847. [PMID: 31653311 DOI: 10.1016/j.clp.2019.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Women are being disproportionately affected by the opioid crisis, including during pregnancy. Pain and other vulnerabilities to addiction differ between men and women. Management of opioid use disorder should be gender informed and accessible across the lifespan. During pregnancy, care teams should be multidisciplinary to include obstetrics, addiction, social work, anesthesia, pediatrics, and behavioral health. Pain management for women with opioid use disorder requires tailored approaches, including integration of trauma-informed care and addressing psychosocial needs. Thus, coordinated continued care by obstetric and addiction providers through pregnancy into postpartum is key to supporting women in recovery.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, 1250 East Marshall Street, Richmond, VA 23298-0268, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore MD 21202, USA.
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, 300 Halket Street, Pittsburgh, PA 15213, USA
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18
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Faherty LJ, Kranz AM, Russell-Fritch J, Patrick SW, Cantor J, Stein BD. Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome. JAMA Netw Open 2019; 2:e1914078. [PMID: 31722022 PMCID: PMC6902764 DOI: 10.1001/jamanetworkopen.2019.14078] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Despite the rapidly changing policy environment regarding substance use during pregnancy, information is lacking on the association of state policies with neonatal abstinence syndrome (NAS). OBJECTIVE To determine if punitive or reporting state policies related to substance use during pregnancy are associated with NAS rates. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study used retrospective, difference-in-difference analysis of live births in the State Inpatient Databases from 8 US states in varying years between January 1, 2003, and December 31, 2014. States without punitive or reporting policies were compared with states with policies before and after policy enactment using logistic regression models adjusted for individual and county-level factors and state and year fixed effects. Analyses were conducted from April 10, 2019, to July 30, 2019. EXPOSURES Time since enactment of state policies related to substance use in pregnancy, county-level rurality and unemployment, and presence of specialized treatment programs for pregnant and postpartum women in a county. MAIN OUTCOME AND MEASURES Rates of NAS. RESULTS Among 4 567 963 live births, 23 377 neonates (0.5%) received a diagnosis of NAS. Among neonates with NAS, 3394 (14.5%) lived in counties without any treatment programs specifically for pregnant and postpartum women, 20 323 (86.9%) lived in metropolitan counties, and 8135 (34.8%) lived in counties in the highest unemployment quartile. In adjusted analyses among neonates in states with punitive policies, odds of NAS were significantly greater during the first full calendar year after enactment (adjusted odds ratio, 1.25; 95% CI, 1.06-1.46; P = .007) and more than 1 full year after enactment (adjusted odds ratio, 1.33; 95% CI, 1.17-1.51; P < .001). After regression adjustment, the annual NAS rate was 46 (95% CI, 43-48) neonates with NAS per 10 000 live births in states without punitive policies; 57 (95% CI, 48-65) neonates with NAS per 10 000 live births in states with punitive policies during the first full year after enactment; and 60 (95% CI, 56-65) neonates with NAS per 10 000 live births in states with punitive policies in effect for more than 1 full year. There was no association between reporting policies and odds of NAS. CONCLUSIONS AND RELEVANCE In this repeated cross-sectional analysis of 8 states, states with punitive policies were associated with greater odds of NAS immediately and in the longer term, but there was no association between NAS and states with reporting policies.
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Affiliation(s)
- Laura J. Faherty
- RAND Corporation, Boston, Massachusetts
- School of Medicine, Boston University, Boston, Massachusetts
| | | | | | - Stephen W. Patrick
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
- RAND Corporation, Pittsburgh, Pennsylvania
| | | | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Ecker J, Abuhamad A, Hill W, Bailit J, Bateman BT, Berghella V, Blake-Lamb T, Guille C, Landau R, Minkoff H, Prabhu M, Rosenthal E, Terplan M, Wright TE, Yonkers KA. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol 2019; 221:B5-B28. [PMID: 30928567 DOI: 10.1016/j.ajog.2019.03.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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20
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Abstract
Pregnancy presents a window of opportunity for effecting positive change in the lives of women with opioid use disorder (OUD). Care should be empathetic and nonjudgmental with a focus on counseling for initiation and maintenance of beneficial health behaviors as well as development of a strong patient-provider relationship.1 These include adherence to treatment of OUD through pharmacotherapy and behavioral counseling, smoking cessation, healthy nutrition, treatment of coexisting medical and psychosocial conditions, as well as preparation for the postpartum period through breastfeeding education and antenatal discussion of contraception. Women will also benefit from anticipatory guidance with regard to neonatal abstinence syndrome (see Chapter 7). This may include a consultation with pediatric or neonatal providers who will be caring for their infants. In the absence of other obstetric indications, minimal additional fetal assessment outside that of standard prenatal care is recommended for OUD.
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Affiliation(s)
- Emily W Rosenthal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, United States.
| | - Jason K Baxter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, United States
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Patton BP, Krans EE, Kim JY, Jarlenski M. The impact of Medicaid expansion on postpartum health care utilization among pregnant women with opioid use disorder. Subst Abus 2019; 40:371-377. [PMID: 30908175 DOI: 10.1080/08897077.2019.1573209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Opioid use disorder (OUD) during pregnancy has increased dramatically over the past decade, as have associated adverse maternal health outcomes. Although Medicaid has long been the largest payer for deliveries in the United States, states' decisions to expand Medicaid eligibility to low-income adults has the potential to increase access to care for women in the postpartum period. This study aimed to determine the impact of the 2015 Pennsylvania Medicaid expansion on postpartum insurance coverage and preventive care utilization among pregnant women with opioid use disorder (OUD). Methods: In 2017, we conducted a retrospective cohort study using 2013-2015 administrative Medicaid data provided by the Pennsylvania Department of Human Services. We identified 1562 women with opioid use disorder who had a live birth delivery in a pre-Medicaid expansion or post-expansion study period. We compared length of continuous enrollment in Medicaid following delivery, postpartum visit attendance, and contraception initiation between groups. Results: More women in the post-expansion group remained enrolled in Medicaid at 300 days postpartum, relative to the pre-expansion group (87% vs. 81%). Medicaid expansion was not associated with differences in postpartum visit attendance or contraceptive use. However, women who remained enrolled in Medicaid for at least 300 days post delivery had an increased odds of postpartum visit attendance (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.04, 2.4). Conclusion: The rate of continuous Medicaid enrollment among postpartum women with OUD was significantly higher after expansion, whereas rates of preventive care utilization were unaffected. Although improving insurance coverage for women with OUD is an important step to improve access to recommended preventive care, additional efforts are needed to ensure utilization of such care.
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Affiliation(s)
- Briana P Patton
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Joo Yeon Kim
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian Jarlenski
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Collier KW, MacAfee LK, Kenny BM, Meyer MC. Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake? J Subst Abuse Treat 2019; 98:73-77. [DOI: 10.1016/j.jsat.2018.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/02/2018] [Accepted: 12/05/2018] [Indexed: 01/01/2023]
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23
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Kotha A, Chen BA, Lewis L, Dunn S, Himes KP, Krans EE. Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder. Contraception 2018; 99:36-41. [PMID: 30114393 DOI: 10.1016/j.contraception.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/20/2018] [Accepted: 08/05/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD. STUDY DESIGN This was a retrospective cohort study of 791 pregnant women with OUD on MAT who delivered at an academic institution without immediate postpartum LARC services between 2009 and 2012. LARC intent was defined as a documented plan for postpartum LARC during pregnancy and LARC receipt was defined as documentation of LARC placement by 8 weeks postpartum. We organized contraceptive methods into five categories: LARC, female sterilization, short-acting methods, barrier methods and no documented method. Multivariable logistic regression identified characteristics predictive of prenatal LARC intent and postpartum LARC receipt. RESULTS Among 791 pregnant women with OUD on MAT, 275 (34.8%) intended to use postpartum LARC and only 237 (29.9%) attended the postpartum visit. Among 275 women with prenatal LARC intent, 124 (45.1%) attended their postpartum visit and 50 (18.2%) received a postpartum LARC. Prenatal contraceptive counseling (OR 6.67; 95% CI 3.21, 13.89) was positively associated with LARC intent. Conversely, older age (OR 0.95; 95% CI 0.91, 0.98) and private practice provider (OR 0.48; 95% CI 0.32, 0.72) were negatively associated with LARC intent. Although parity was not predictive of LARC intent, primiparous patients (CI 0.49; 95% CI 0.26, 0.97) were less likely to receive postpartum LARC. CONCLUSIONS Discrepancies exist between prenatal intent and postpartum receipt of LARC among pregnant women with OUD on MAT. Immediate postpartum LARC services may reduce LARC access barriers. IMPLICATIONS 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.
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Affiliation(s)
- Anupama Kotha
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15260
| | - Beatrice A Chen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15260; Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213
| | - Lauren Lewis
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, 114 Woodland St., Hartford, CT 06105
| | - Shannon Dunn
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213
| | - Katherine P Himes
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15260; Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15260; Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213.
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