Abstract
Background
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.
Results
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.
Conclusions
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.
Implications
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.
Keywords
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Article info
Publication history
Published online: August 13, 2018
Accepted:
August 5,
2018
Received in revised form:
July 20,
2018
Received:
April 20,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
