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Medication-Assisted Treatment Use Among Pregnant Women With Opioid Use Disorder

Krans, Elizabeth E., MD, MSc; Kim, Joo Yeon, MS; James, Alton Everette III, JD, MBA; Kelley, David, MD; Jarlenski, Marian P., PhD, MPH

doi: 10.1097/AOG.0000000000003231
Contents: Substance Use Disorder: Original Research

OBJECTIVE: To evaluate temporal trends in medication-assisted treatment use among pregnant women with opioid use disorder.

METHODS: We conducted a retrospective cohort study using Pennsylvania Medicaid administrative data. Trends in medication-assisted treatment use, opioid pharmacotherapy (methadone and buprenorphine) and behavioral health counselling, were calculated using pharmacy records and procedure codes. Cochrane-Armitage tests evaluated linear trends in characteristics of pregnant women using methadone compared with buprenorphine.

RESULTS: In total, we evaluated 12,587 pregnancies among 10,741 women with opioid use disorder who had a live birth between 2009 and 2015. Across all years, 44.1% of pregnant women received no opioid pharmacotherapy, 27.1% used buprenorphine, and 28.8% methadone. Fewer than half of women had any behavioral health counseling during pregnancy. The adjusted prevalence of methadone use declined from 31.6% (95% CI 29.3–33.9%) in 2009 to 25.2% (95% CI 23.3–27.1%) in 2015, whereas the adjusted prevalence of buprenorphine use increased from 15.8% (95% CI 13.9–17.8%) to 30.9% (95% CI 28.8–33.0%). Greater increases in buprenorphine use were found in geographic regions with large metropolitan centers, such as the Southwest (plus 24.9%) and the Southeast (plus 12.0%), compared with largely rural regions, such as the New West (plus 5.2%). In 2015, the adjusted number of behavioral health counseling visits during pregnancy was 3.4 (95% CI 2.6–4.1) among women using buprenorphine, 4.0 (95% CI 3.3–4.7) among women who did not use pharmacotherapy, and 6.4 (95% CI 4.9–7.9) among women using methadone.

CONCLUSION: Buprenorphine use among Medicaid-enrolled pregnant women with opioid use disorder increased significantly over time, with a small concurrent decline in methadone use. Behavioral health counseling use was low, but highest among women using methadone.

Although medication-assisted treatment use during pregnancy increased over the past decade, gaps between treatment need and receipt remain.

Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, and the Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, and the Pennsylvania Department of Human Services, Harrisburg, Pennsylvania.

Corresponding author: Elizabeth E. Krans, MD, MSc, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213; email:

Research reported in this publication was supported by the National Institute on Drug Abuse under Award Number K23DA038789 (Krans) and R01DA045675 (Krans and Jarlenski). This research was also supported by an inter-governmental agreement between the University of Pittsburgh and the Pennsylvania Department of Human Services.

Each author has confirmed compliance with the journal's requirements for authorship.

Financial Disclosure Dr. Krans is an investigator on grants to Magee-Womens Research Institute from the National Institutes of Health, Gilead, and Merck outside of the submitted work. The other authors did not report any potential conflicts of interest.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.