542 Postpartum contraceptive choice and fulfilment in patients with opioid use disorder

Abstract

Rates of unintended pregnancy in women with opioid use disorder (OUD) are higher than the general population, which may be explained by lower utilization of postpartum contraception. Therefore, we sought to examine the differences in postpartum contraceptive outcomes in women with and without OUD. A retrospective cohort analysis of deliveries occurring from 2012-2014 at an urban tertiary care institution. Clinical and demographic data were obtained from individual chart review and differences between patients with and without OUD were compared. Outcomes included tier of efficacy for planned method of contraception, plan fulfillment within 90 days postpartum, postpartum visit attendance, and subsequent pregnancy within 365 days of the index delivery. Tests of differences, univariable and multivariable logistic regression, and propensity score matched samples using genetic matching algorithm was used to analyze outcomes. Of 8,654 deliveries during the study period, 200 (2.3%) were complicated by OUD. Women with OUD were significantly more likely to be white and not receive adequate prenatal care (Table 1). After propensity matching, women with OUD were less likely to choose a highly effective vs moderately effective method than women without OUD (matched odds ratio [mOR] 0.24, 95% confidence interval [CI] 0.05-0.93) and were less likely to have their contraceptive plan fulfilled (mOR 0.64, 95% CI 0.42-0.99) (Table 2). There was no difference in postpartum visit attendance (mOR 1.08, 95% CI 0.73-1.61) or the rate of short interval pregnancy (mOR 1.15, 95% CI 0.73-1.80). Clinical and demographic characteristics were similar between women with and without OUD in our urban tertiary care center. System level barriers may account for less frequent fulfilment of contraceptive plans among women with OUD in pregnancy. Clinicians should be mindful of addressing the contraceptive needs of these patients prior to and after delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)