Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake?

Abstract

IntroductionWomen with opioid use disorder have higher rates of unplanned pregnancies, shorter interpregnancy intervals and lower rates of contraceptive use compared to women without substance use disorders. This contributes to worse perinatal and reproductive health outcomes for this population. It has been suggested that co-location of medication assisted treatment (MAT) and reproductive health services could allow for improved outcomes among women with substance use disorders. The aim of this study was to determine if location where women received MAT influenced their pregnancy planning, interpregnancy interval or uptake of postpartum contraception between subsequent pregnancies. MethodsWe conducted a retrospective chart review at the University of Vermont Medical Center (UVMMC). Women were eligible for the study if they had two consecutive deliveries at UVMMC between 2009 and 2015 and if they received MAT during one or both pregnancies. Women in this community can receive MAT through a public MAT opioid treatment program (methadone or buprenorphine), a community MAT program (buprenorphine), or through an obstetric provider with co-location of prenatal care and MAT (buprenorphine). Demographics and maternal and neonatal outcomes were collected and descriptive statistics were performed. ResultsA total of 98 women were included in the study. Of the women with documented pregnancy intention status, 84% were unplanned, for both pregnancies. Over half of women had a short interpregnancy interval (56.1%), defined as <18 months between consecutive pregnancies. Half of women (50%) did not receive any contraceptive method in the postpartum period. Furthermore, many patients (42.2%) desired long acting reversible contraception (LARC), but only 9.3% received it. Outcomes were not statistically different among the models of care. DiscussionColocation of MAT with antenatal care did not improve pregnancy planning, interpregnancy interval, or uptake of postpartum contraception. Decisions regarding family planning and continued engagement with the health care system following pregnancy remain challenges in this group of women.