Introduction: Delaying pregnancy allows people with opioid use disorder (OUD) to choose when they are ready to continue their families. We aim to address the lack of characterization of postpartum contraceptive uptake among people with OUD compared to people without OUD. Methods: Analyses used 73,811 pregnancy episodes among 61,221 people (2016-2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. Contraceptive uptake was defined within 90-days after delivery. We used generalized estimating equations to assess the association of OUD +/- co-occurring substance use disorders (SUDs) with any contraception (yes/no) and type of contraception (effective – pills, patch, vaginal ring, injection, or highly effective – long-acting reversible, LARC methods (intrauterine device, implant) and sterilization).
Results: The sample was 66.0% white and average age was 27.7 years (±5.6). About one-third of pregnancies were followed by contraception initiation, 2.3% had an associated OUD diagnosis, and 1.3% OUD with co-occurring SUD. There was no association between OUD and 90-day postpartum contraception receipt, but OUD was associated with decreased receipt of postpartum LARC methods and sterilization compared to user-dependent methods such as oral contraception (aOR=0.76; 95% CI: [0.64-0.91]). Having a co-occurring SUD in addition to OUD was associated with decreased postpartum contraception uptake across all contraception types (aOR=0.81[0.70-0.93]) and highly-effective methods specifically (aOR=0.48[0.38-0.61]).
Impact: Overall contraception uptake among people with OUD is comparable to uptake in the non-OUD population. Those having co-occurring SUDs in addition to OUD are particularly unlikely to receive contraception. The reasons people choose contraceptive methods are complex, and not solely based on method effectiveness and may differ based on severity of substance use disorder. More information is needed to understand the complex factors that impact decision making around postpartum contraception initiation that maintains patient autonomy and reduces stigma.
Organization: Saint Louis University
Bello Kottenstette J, Xu K, Salas J, Kelly J, Grucza R