(244) Asked but not received: Postpartum Contraceptive characteristics in Women with Opioid Use Disorder (OUD)

To identify differences between desired and received postpartum contraception in pregnant patients with OUD.

Study Design:

This is a retrospective chart review of patients with a positive UDS for opioids with a documented contraceptive plan who delivered between December 1, 2016 and December 31, 2020 at our University Hospital. Patients who did not deliver at our institution, those taking hospital administered opioids, those without a documented birth control plan, and those with a urine drug screen negative for opioids were excluded.  Associations between desired/received contraceptive types and other demographic and clinical factors were performed using multinomial regression models for continuous factors and chi-square/Fisher tests for categorical factors.

Results:

101 patients met criteria for evaluation. Over 2/3 of patients did not receive their desired form of contraception at the time of discharge. Long acting reversible contraception (LARC) was the most desired form of contraception at time of admission, with 56% of patients desiring a LARC for contraception. Despite only being desired by 9% at time of admission, Depo-Provera was the most common contraception given at the time of discharge administered to 33%. 32% of patients received no contraception at the time of discharge. 4% of patients left against medical advice prior to prescription of a birth control method. Only 25% of patients presented for a postpartum follow up appointment. Of the women who did not receive their desired form of contraception at time of discharge, 28% were pregnant again within two years. There was a significantly increased risk of perinatal and antenatal complications in this cohort including: overdose in 1 year (12%), repeat admission with an intrauterine fetal demise (4%), death in 1 year (4%) and more.

Conclusion:

Increased focus is needed on the prevention of unintended pregnancies in women with OUD including policies to increase access to contraception including LARCS.   Supporting intentional family planning can have multiple health benefits and reduce harms related to OUD.