1022 Opioid maintenance therapy prescription by obstetricians and postpartum visit compliance

Abstract

Women with opioid use disorders (OUD) are particularly vulnerable in the postpartum period. Increased rates of mental health crises and relapse rates underscore the importance of compliance with postpartum care in this population. This study aimed to evaluate the relationship of the provider prescribing opioid maintenance therapy (OMT) and the subsequent compliance with the 6 week postpartum (PP) visit. This retrospective cohort study identified patients through the institutions’ Maternal Opioid Management Support (MOMS) program as those receiving OMT (defined as use of methadone or buprenorphine) from 2017 to 2020. The primary outcome was attendance of the 6 week PP visit. Prenatal care provider comparison was done between the MOMS clinic and other obstetric providers. Statistical analysis included Chi square tests, student t tests, and logistic regression modeling and was performed with significance levels of <0.05 using R Studio (V1.2.5042). Characteristics independently associated with compliance were included in the model. Of 199 women receiving OMT during pregnancy, 54.8% (109) were compliant with the 6 week PP visit and 45.2% (90) were noncompliant. Both groups demonstrated similarity in maternal age, race, marital status, employment, detox during pregnancy, active drug use in pregnancy, gestational age at delivery, and maternal comorbidities. Among the 109 women compliant with their PP care, 83% received OMT from an OB prescriber vs 40% by a non-OB prescribers (e.g. methadone/pain clinic, PCP) (p= <0.001). In a regression model, having a postpartum OB OMT prescriber was an independent predictor of 6 week PP visit compliance (OR 5.40; 95%CI: 2.35 – 13.36). (Table 1) Access to OMT received directly from a woman’s prenatal provider may be a predictive factor in increasing PP visit compliance. Additionally, it provides an important opportunity to screen, support, and treat this population of women who are at a significantly elevated risk of complications.