According to a recent analysis of national data by the Centers for Disease Control, the number of pregnant women with opioid use disorder (as documented at the time of delivery) more than quadrupled from 1999 through 2014. While many women are able to decrease or abstain from opioid use during pregnancy, the first year postpartum is a particularly vulnerable time for women with opioid use disorder.  Relapse is common, and studies have noted increased rates of both fatal and non-fatal overdoses during the postpartum period.  Given this significant vulnerability, it is essential that women with opioid use disorders continue in treatment throughout pregnancy and into the postpartum period, ideally with medication assisted therapy.  

In a recent population-based retrospective cohort study, researchers from the MGH Departments of Obstetrics and Gynecology and Psychiatry used linked administrative data from 211,096 deliveries in Massachusetts between 2011 and 2014 in order to examine the use of medications to treat opioid use disorder (MOUD).

In this cohort, 2,314 women were receiving MOUD (methadone or buprenorphine) at the time of delivery; 64.1% (1,484) continued receiving MOUD for a full year following delivery. Rates of MOUD continuation varied; continuation was the highest in women who used MOUD throughout pregnancy (80%) and the lowest in women who initiated MOUD during the month before delivery (34%). The most robust predictors of discontinuation were MOUD duration of less than four months during pregnancy (adjusted hazards ratio or aHR = 3.26) and incarceration during pregnancy or the postpartum period (aHR = 1.79).

The American College of Obstetricians and Gynecologists (ACOG) recommends universal screening for substance use disorders to be carried out at the first prenatal visit with a validated verbal screening tools. This is an opportunity to engage women in treatment early during the pregnancy, and the current study indicates that it may be possible to improve postpartum outcomes in women with opioid use disorders if MOUD is initiated early in pregnancy.  While discontinuation of MOUD is common in women who initiate treatment proximate to delivery, the authors suggest that the provision of additional supports, such as home visiting nurses and peer support programs, may be useful in improving adherence to MOUD following delivery. 

 

Ruta Nonacs. MD PhD

 

Schiff DM, Nielsen TC, Hoeppner BB, Terplan M, Hadland SE, Bernson D, Greenfield SF, Bernstein J, Bharel M, Reddy J, Taveras EM, Kelly JF, Wilens TE.  Methadone and Buprenorphine Discontinuation among Postpartum Women with Opioid Use Disorder.  Am J Obstet Gynecol. 2021 Apr 9: