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Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

Brogly, Susan B., PhD, MSc; Saia, Kelley E., MD; Werler, Martha M., ScD; Regan, Emily, BA; Hernández-Díaz, Sonia, DrPH, MD

doi: 10.1097/AOG.0000000000002881
Opioids: Original Research: PDF Only

OBJECTIVE: To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder.

METHODS: Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts.

RESULTS: Most women in the cohort were non-Hispanic white (80.5%) with a mean age of 28 years. Few women were married (8.9%). More than half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) were infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychologic (0.375±0.187) Addiction Severity Index scores were the highest, indicating the most severe problems in these areas. Opioid use relapse did not differ by treatment (44.7% overall). Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (n=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7–95.9).

CONCLUSION: These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population.

Pregnant women with opioid use disorder are a clinically complex population with prevalent polysubstance use, economic instability, legal problems, trauma histories, and comorbidities.

Department of Surgery, Queen's University, Kingston, Ontario, Canada; and the Department of Obstetrics & Gynecology, Boston University, the Department of Epidemiology, Boston University School of Public Health, and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Corresponding author: Susan B. Brogly, PhD, MSc, Department of Surgery, Queen's University, 76 Stuart Street, Victory 3, Kingston, ON, Canada K7L 2V7; email: susan.brogly@queensu.ca.

This publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under grant number 1R21HD081271-01 REVISED (S. B. Brogly). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received May 09, 2018

Received in revised form June 28, 2018

Accepted July 12, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.