The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care

Abstract

Objective To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD.

Study Design This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic—Clinic for Acceptance Recovery and Empowerment (CARE)—between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations.

Results A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05–1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76–1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36–1.84).

Conclusion In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception.

Key Points

• Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.

• Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.

• Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic.

Keywords

opioid use disorder - multidisciplinary prenatal clinic - breastfeeding - contraception - postpartum

Publikationsverlauf

Eingereicht: 24. August 2021

Angenommen: 18. Februar 2022

Artikel online veröffentlicht:
03. Juni 2022

• References

• 1 Substance Abuse and Mental Health Services Administration.. Behavioral Health Barometer: United States, Volume 4: Indicators as Measured through the 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2017
• 2 Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization - United States, 1999-2014. MMWR Morb Mortal Wkly Rep 2018; 67 (31) 845-849
• 3 Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M. Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database Syst Rev 2013; (12) CD006318
• 4 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
• 5 Heil SH, Jones HE, Arria A. et al. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2011; 40 (02) 199-202
• 6 Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med 2016; 374 (09) 843-852
• 7 CDC.. Unintended Pregnancy CDC. 2021 . Accessed March 18, 2022 at: https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/index.htm
• 8 Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009; 116 (05) 665-671
• 9 Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr 2013; 102 (11) 1060-1066
• 10 Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117 (06) e1163-e1169
• 11 Committee Opinion No. Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017; 130 (02) e81-e94
• 12 Yonke N, Jimenez EY, Leeman L, Leyva Y, Ortega A, Bakhireva LN. Breastfeeding motivators and barriers in women receiving medications for opioid use disorder. Breastfeed Med 2020; 15 (01) 17-23
• 13 CDC.. CDC: Breastfeeding Report Card. 2014 . Accessed August 4, 2021 at: https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
• 14 Tsai LC, Doan TJ. Breastfeeding among mothers on opioid maintenance treatment: a literature review. J Hum Lact 2016; 32 (03) 521-529
• 15 Kim TY, Dagher RK, Chen J. Racial/ethnic differences in unintended pregnancy: evidence from a national sample of U.S. women. Am J Prev Med 2016; 50 (04) 427-435
• 16 Black KI, Stephens C, Haber PS, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust N Z J Obstet Gynaecol 2012; 52 (02) 146-150
• 17 Krans EE, Kim JY, James III AE, Kelley DK, Jarlenski M. Postpartum contraceptive use and interpregnancy interval among women with opioid use disorder. Drug Alcohol Depend 2018; 185: 207-213
• 18 Kotha A, Chen BA, Lewis L, Dunn S, Himes KP, Krans EE. Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder. Contraception 2019; 99 (01) 36-41
• 19 Krans EE, Cochran G, Bogen DL. Caring for opioid-dependent pregnant women: prenatal and postpartum care considerations. Clin Obstet Gynecol 2015; 58 (02) 370-379
• 20 Bedrick BS, O'Donnell C, Marx CM. et al. Barriers to accessing opioid agonist therapy in pregnancy. Am J Obstet Gynecol MFM 2020; 2 (04) 100225
• 21 Holmes AP, Schmidlin HN, Kurzum EN. Breastfeeding considerations for mothers of infants with neonatal abstinence syndrome. Pharmacotherapy 2017; 37 (07) 861-869
• 22 Patrick SW, Buntin MB, Martin PR. et al. Barriers to accessing treatment for pregnant women with opioid use disorder in Appalachian states. Subst Abus 2019; 40 (03) 356-362
• 23 Short VL, Hand DJ, MacAfee L, Abatemarco DJ, Terplan M. Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States. J Subst Abuse Treat 2018; 89: 67-74
• 24 Martin CE, Longinaker N, Terplan M. Recent trends in treatment admissions for prescription opioid abuse during pregnancy. J Subst Abuse Treat 2015; 48 (01) 37-42
• 25 Step 10: Strives to Achieve the WHO/UNICEF Ten Steps of the Baby-Friendly Hospital Initiative to Promote Successful Breastfeeding: The Coalition for Improving Maternity Services. J Perinat Educ 2007; 16 (Suppl. 01) 79S-80S
• 26 Lee SH, Lee SM, Lim NG. et al. Differences in pregnancy outcomes, prenatal care utilization, and maternal complications between teenagers and adult women in Korea: a nationwide epidemiological study. Medicine (Baltimore) 2016; 95 (34) e4630
• 27 Rowe S, Karkhaneh Z, MacDonald I. et al. Systematic review of the measurement properties of indices of prenatal care utilization. BMC Pregnancy Childbirth 2020; 20 (01) 171
• 28 Terplan M, Hand DJ, Hutchinson M, Salisbury-Afshar E, Heil SH. Contraceptive use and method choice among women with opioid and other substance use disorders: a systematic review. Prev Med 2015; 80: 23-31
• 29 Schiff DM, Nielsen T, Terplan M. et al. Fatal and nonfatal overdose among pregnant and postpartum women in Massachusetts. Obstet Gynecol 2018; 132 (02) 466-474
• 30 Whiteman VE, Salemi JL, Mogos MF, Cain MA, Aliyu MH, Salihu HM. Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy 2014; 2014: 906723
• 31 Unger A, Metz V, Fischer G. Opioid dependent and pregnant: what are the best options for mothers and neonates?. Obstet Gynecol Int 2012; 2012: 195954