A set of demographic, substance use, and treatment characteristics has been found to have a high prevalence in pregnant women with opioid use disorder and may be helpful in treating this patient population, according to a study published in Obstetrics & Gynecology.
The study included women who attended an obstetric and addiction recovery clinic in Boston from 2015 to 2016 (n=113). Participants were treated with buprenorphine or methadone, followed through delivery, and administered the Addiction Severity Index questionnaire upon enrollment. Prenatal and delivery data was gathered from medical charts.
A majority of participants (80.5%) were non-Hispanic white women with a mean age of 28. A total of 8.9% of women were married, 51.3% had been previously incarcerated, 29.2% had current legal involvement, and 15.0% had unstable housing. Hepatitis C infection was common in this cohort (70.8%), and 56.6% and 65.5% of women had a history of sexual abuse or physical abuse, respectively. Women reported using heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), or cocaine (62.8%). A total of 59 women (52.2%) were treated with prenatal buprenorphine, and 54 participants (47.8%) were treated with methadone, with 49.6% of participants taking concomitant psychotropic medications.
The highest Addiction Severity Index scores were in the employment (0.766±0.289) and psychological (0.375±0.187) domains, indicating that these were the most severe issues in these areas. Opioid use relapse rates were comparable across treatments (44.7%). Of the 59 women who started on buprenorphine, 13 transitioned to methadone, mainly due to positive opioid screenings. During the study period, 23.0% of participants discontinued clinical care. The live birth rate was 90.8%, with 3 therapeutic abortions, 4 miscarriages, and 1 stillbirth.
“The multitude of issues faced by these women in pregnancy likely cannot be addressed and resolved in the prenatal period alone,” the researchers wrote. “Comprehensive, postnatal medical care, counseling, and social support should be accessible for all women.”
Brogly SB, Saia KE, Werler MM, et al. Prenatal treatment and outcomes of women with opioid use disorder. [published online September 7, 2018]. Obstet Gynecol. doi:10.1097/AOG.0000000000002881