The Opioid Epidemic Among Pregnant Women: Treatments For Opioid Use Disorder And Their Association With Pregnancy And Maternal Outcomes

Background: Opioid epidemic has been a severe public health problem, so various national and state efforts were made to address the opioid crisis. Despite these efforts, the number of pregnant women with opioid use disorder (OUD) significantly increased over time. Opioid use during pregnancy is associated with several adverse maternal and neonatal outcomes, including preeclampsia, preterm birth, low birth weight, neonatal opioid withdrawal syndrome (NOWS), and postpartum depression. Several treatment options are available for OUD for pregnant women. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. In addition, little is known about the impact of early initiation of treatment for OUD on pregnancy and maternal outcomes.

Methods: Using Merative MarketScan® Commercial Claims and Encounters data from 2005 to 2019, I identified women aged 13-49 who gave birth in 2006-2019 and had an opioid-related problem (ORP) during the year prior to or at delivery. We then identified women who received their first treatment for OUD (medications or behavioral health services) during the year prior to or at delivery. With this study cohort, I conducted two studies. In the paper 1, I assessed changes in annual rates of treatment for OUD among pregnant women, and demonstrated at what stage of pregnancy care was initiated and how timing of treatment initiation changed over time. In the paper 2, I examined the impact of early initiation of treatment for OUD on pregnancy and maternal outcomes.

Results: Of the pregnant women with ORP, 63.9% received any treatment for OUD. Rates of the treatment increased from 44.2% in 2006 to 69.1% in 2019, and a higher portion of women initiated care prior to conception (50% in 2006 vs 69.6% in 2019). However, over 30% of pregnant women with ORP did not receive any treatment for their OUD in 2019, and more than 15% of pregnant women still did not initiate care until the 2nd trimester. In terms of association of early treatment initiation for OUD with pregnancy and maternal outcomes, women who initiated their OUD treatment prior to conception (aOR, 0.46; 95% CI, 0.31-0.68) or in the first trimester (aOR, 0.59; 95% CI, 0.37-0.94) were less likely to have preterm birth. In addition, women who initiated OUD treatment in the first trimester were less likely to have postpartum depression (aOR, 0.53; 95% CI, 0.28-0.98). Having mental health comorbidities or any substance use disorder were associated with higher odds of having preterm birth, postpartum depression, or emergency department visits related to ORP.

Conclusion: Overall, rate of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD either received no treatment or did not initiate care until the 3rd trimester. These might show that many pregnant women are facing barriers to access to care for their OUD. My study findings also show that early treatment initiation for OUD is associated with improved health outcomes. Several medical organizations recommended that pregnant women with OUD receive opioid treatment as early as possible during pregnancy. There should be more policies and efforts to encourage pregnant women be screened to identify any opioid-related problems they might have before or early in pregnancy. In addition, improving access to opioid treatment services would be essential for pregnant women to receive timely appropriate care for their and their infants’ health outcomes.

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Work Title The Opioid Epidemic Among Pregnant Women: Treatments For Opioid Use Disorder And Their Association With Pregnancy And Maternal Outcomes
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Open Access
Creators
  1. Kyungha Kim
Keyword
  1. Opioid use disorder
  2. Treatment for opioid use disorder
  3. Timing of treatment initiation
  4. Pregnancy
  5. Pregnancy and maternal outcomes
  6. Opioid-related problems
License In Copyright (Rights Reserved)
Work Type Dissertation
Acknowledgments
  1. Committee members
Publication Date January 4, 2023
Deposited January 04, 2023

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