Original research article| Volume 99, ISSUE 1, P36-41, January 2019

Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder



      Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD.

      Study design

      This was a retrospective cohort study of 791 pregnant women with OUD on MAT who delivered at an academic institution without immediate postpartum LARC services between 2009 and 2012. LARC intent was defined as a documented plan for postpartum LARC during pregnancy and LARC receipt was defined as documentation of LARC placement by 8 weeks postpartum. We organized contraceptive methods into five categories: LARC, female sterilization, short-acting methods, barrier methods and no documented method. Multivariable logistic regression identified characteristics predictive of prenatal LARC intent and postpartum LARC receipt.


      Among 791 pregnant women with OUD on MAT, 275 (34.8%) intended to use postpartum LARC and only 237 (29.9%) attended the postpartum visit. Among 275 women with prenatal LARC intent, 124 (45.1%) attended their postpartum visit and 50 (18.2%) received a postpartum LARC. Prenatal contraceptive counseling (OR 6.67; 95% CI 3.21, 13.89) was positively associated with LARC intent. Conversely, older age (OR 0.95; 95% CI 0.91, 0.98) and private practice provider (OR 0.48; 95% CI 0.32, 0.72) were negatively associated with LARC intent. Although parity was not predictive of LARC intent, primiparous patients (CI 0.49; 95% CI 0.26, 0.97) were less likely to receive postpartum LARC.


      Discrepancies exist between prenatal intent and postpartum receipt of LARC among pregnant women with OUD on MAT. Immediate postpartum LARC services may reduce LARC access barriers.


      Despite prenatal interest in using LARC, most pregnant women with OUD on MAT did not receive postpartum LARC. The provision of immediate postpartum LARC services may reduce barriers to postpartum LARC receipt such as poor attendance at the postpartum visit.


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        • Heil S.H.
        • Jones H.E.
        • Arria A.
        • Kaltenbach K.
        • Coyle M.
        • Fischer G.
        • et al.
        Unintended pregnancy in opioid-abusing women.
        J Subst Abus Treat. 2011; 40: 199-202
        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374: 843-852
        • Black K.I.
        • Stephens C.
        • Haber P.S.
        • Lintzeris N.
        Unplanned pregnancy and contraceptive use in women attending drug treatment services.
        Aust N Z J Obstet Gynaecol. 2012; 52: 146-150
        • Terplan M.
        • Hand D.J.
        • Hutchinson M.
        • Salisbury-Afshar E.
        • Heil S.H.
        Contraceptive use and method choice among women with opioid and other substance use disorders: a systematic review.
        Prev Med. 2015; 80: 23-31
        • Krans E.E.
        • Cochran G.
        • Bogen D.L.
        Caring for opioid-dependent pregnant women: prenatal and postpartum care considerations.
        Clin Obstet Gynecol. 2015; 58: 370-379
        • Krans E.E.
        • Kim J.Y.
        • James III, A.E.
        • Kelley D.K.
        • Jarlenski M.
        Postpartum contraceptive use and interpregnancy interval among women with opioid use disorder.
        Drug Alcohol Depend. 2018; 185: 207-213
        • Thiel de Bocanegra H.
        • Braughton M.
        • Bradsberry M.
        • Howell M.
        • Logan J.
        • Schwarz E.B.
        Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program.
        Am J Obstet Gynecol. 2017; 217: 47.e1-47.e7
        • Krans E.E.
        • Zickmund S.L.
        • Rustgi V.K.
        • Park S.Y.
        • Dunn S.L.
        • Schwarz E.B.
        Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: a retrospective cohort study.
        Subst Abus. 2016; 37: 88-95
        • Krans E.E.
        • Bogen D.
        • Richardson G.
        • Park S.Y.
        • Dunn S.L.
        • Day N.
        Factors associated with buprenorphine versus methadone use in pregnancy.
        Subst Abus. 2016; 37: 550-557
        • Harrell F.E.
        Regression modeling strategies: With applications to linear models, logistic regression, and survival analysis.
        Springer, New York2001
      1. Obstet Gynecol. 2017; 130: e251-e69
        • Matusiewicz A.K.
        • Melbostad H.S.
        • Heil S.H.
        Knowledge of and concerns about long-acting reversible contraception among women in medication-assisted treatment for opioid use disorder.
        Contraception. 2017; 96: 365-369
        • Ogburn J.A.
        • Espey E.
        • Stonehocker J.
        Barriers to intrauterine device insertion in postpartum women.
        Contraception. 2005; 72: 426-429
        • Engin-Ustun Y.
        • Ustun Y.
        • Cetin F.
        • Meydanli M.M.
        • Kafkasli A.
        • Sezgin B.
        Effect of postpartum counseling on postpartum contraceptive use.
        Arch Gynecol Obstet. 2007; 275: 429-432
        • Chen B.A.
        • Reeves M.F.
        • Hayes J.L.
        • Hohmann H.L.
        • Perriera L.K.
        • Creinin M.D.
        Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.
        Obstet Gynecol. 2010; 116: 1079-1087
      2. Obstet Gynecol. 2018; 131: e140-e150
        • Baldwin M.K.
        • Hart K.D.
        • Rodriquez M.I.
        Predictors for follow-up among postpartum patients enrolled in a clinical trial.
        Contraception. 2018; ([Epub ahead of print])
        • Krans E.E.
        • Tong S.T.
        • Terplan M.
        Postpartum care for women with substance use disorders.
        in: Wright T.E. Opioid use disorders in pregnancy: Management guidelines for improving outcomes. Cambridge University Press, Cambridge, UK2018: 113-126
        • American College of Obstetrics and Gynecologists
        • Committee on Obstetric Practice
        Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception.
        Obstet Gynecol. 2016; 128: e32-e37
        • Connolly A.
        • Thorp J.
        • Pahel L.
        Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study.
        Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 263-267
        • Hofler L.G.
        • Cordes S.
        • Cwiak C.A.
        • Goedken P.
        • Jamieson D.J.
        • Kottke M.
        Implementing immediate postpartum long-acting reversible contraception programs.
        Obstet Gynecol. 2017; 129: 3-9
      3. Medicaid Reimbursement for Postpartum LARC by State.
        (Accessed at) (on June 29th, 2018)
        • Uhm S.
        • Pope R.
        • Schmidt A.
        • Bazella C.
        • Perriera L.
        Home or office etonogestrel implant insertion after pregnancy: a randomized trial.
        Contraception. 2016; 94: 567-571
        • Schauberger C.W.
        • Newbury E.J.
        • Colburn J.M.
        • Al-Hamadani M.
        Prevalence of illicit drug use in pregnant women in a Wisconsin private practice setting.
        Am J Obstet Gynecol. 2014; 211
        • Krans E.E.
        • Bobby S.
        • England M.
        • Gedekoh R.H.
        • Chang J.C.
        • Maguire B.
        • et al.
        The pregnancy recovery center: a women-centered treatment program for pregnant and postpartum women with opioid use disorder.
        Addict Behav. 2018; 24 ([Epub ahead of print])