TY - JOUR
T1 - Postpartum contraceptive use and interpregnancy interval among women with opioid use disorder
AU - Krans, Elizabeth E.
AU - Kim, Joo Yeon
AU - James, Alton Everette
AU - Kelley, David K.
AU - Jarlenski, Marian
N1 - Funding Information:
Research reported in this publication was partially supported by an inter-governmental agreement between the University of Pittsburgh and the Pennsylvania Department of Human Services , the National Institute on Drug Abu se under Award Number K23DA038789 (Dr. Krans) and the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Program under Award Number K12HD043441 (Dr. Jarlenski).
Publisher Copyright:
© 2018
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objective: The purpose of this study was to describe postpartum contraceptive utilization patterns among women with OUD and evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Methods: A retrospective cohort study was conducted with women in Pennsylvania Medicaid with a diagnosis of OUD between 2008 and 2013. Postpartum contraceptive use within 90 days after delivery was identified through claims data and categorized by effectiveness (highly-effective, effective, and no method observed). Kaplan-Meier time-to-event analyses and multivariable-adjusted marginal Cox regression models were used to evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Multivariable logistic regression analyses were used to identify risk factors predictive of a short interpregnancy interval (≤18 months). Results: We identified 7805 women (9260 pregnancies) who had a diagnosis of OUD. Nearly three-quarters (74.5%) had no contraceptive method observed, 18.1% received an effective method, and only 7.4% received a highly-effective method (LARC or female sterilization) during the postpartum period. In Kaplan-Meier analyses, no significant differences were found in the time-to-next pregnancy interval when an effective contraceptive method vs. no contraceptive method was used. In multivariable analysis, predictors of a significantly longer interpregnancy interval were LARC use (HR 0.43, 95% CI 0.26–0.69), gestational hypertension (HR 0.80, 95% CI 0.65–0.97), and age (HR 0.95, 95% CI 0.94–0.96). Approximately 20% of women with OUD had a short interpregnancy interval. Conclusion: Few women with OUD use highly-effective postpartum contraception, which is protective against short interpregnancy intervals.
AB - Objective: The purpose of this study was to describe postpartum contraceptive utilization patterns among women with OUD and evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Methods: A retrospective cohort study was conducted with women in Pennsylvania Medicaid with a diagnosis of OUD between 2008 and 2013. Postpartum contraceptive use within 90 days after delivery was identified through claims data and categorized by effectiveness (highly-effective, effective, and no method observed). Kaplan-Meier time-to-event analyses and multivariable-adjusted marginal Cox regression models were used to evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Multivariable logistic regression analyses were used to identify risk factors predictive of a short interpregnancy interval (≤18 months). Results: We identified 7805 women (9260 pregnancies) who had a diagnosis of OUD. Nearly three-quarters (74.5%) had no contraceptive method observed, 18.1% received an effective method, and only 7.4% received a highly-effective method (LARC or female sterilization) during the postpartum period. In Kaplan-Meier analyses, no significant differences were found in the time-to-next pregnancy interval when an effective contraceptive method vs. no contraceptive method was used. In multivariable analysis, predictors of a significantly longer interpregnancy interval were LARC use (HR 0.43, 95% CI 0.26–0.69), gestational hypertension (HR 0.80, 95% CI 0.65–0.97), and age (HR 0.95, 95% CI 0.94–0.96). Approximately 20% of women with OUD had a short interpregnancy interval. Conclusion: Few women with OUD use highly-effective postpartum contraception, which is protective against short interpregnancy intervals.
KW - Contraception
KW - Interpregnancy interval
KW - Opioid use disorder
KW - Postpartum
KW - Pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85044660339&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2017.12.023
DO - 10.1016/j.drugalcdep.2017.12.023
M3 - Article
C2 - 29462768
AN - SCOPUS:85044660339
VL - 185
SP - 207
EP - 213
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -