Brogly SB, et al. - In pregnant women with opioid use disorder, this prospective cohort study was undertaken to characterize the traits, treatment, and outcomes. Data suggest these pregnant women represent a clinically complex population with prevalent polysubstance use, economic instability, legal problems, trauma histories, and comorbidities.

Methods

• Researchers enrolled women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 in a prospective cohort study and followed them through delivery (N=113).
• Clinically, buprenorphine or methadone was administered to the women.
• They administered the Addiction Severity Index at enrollment.
• Medical charts were used to abstract prenatal and delivery data systematically.

Results

• The cohort was comprised of non-Hispanic white (80.5%) women mostly; mean age was 28 years and only 8.9% of the women were married.
• In this cohort, more than half had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing.
• Hepatitis C infection (70.8%) and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent in majority of these women.
• Heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%) were used by this cohort.
• Initially, treatment with prenatal buprenorphine was provided to 59 women (52.2%) and with methadone to 54 women (47.8%); 49.6% were also receiving concomitant psychotropic medications.
• Choice of treatment did not impact opioid use relapse (44.7% overall).
• Positive opioid screens mainly accounted for transition to methadone among 13 (22.5%) of 59 women treated with buprenorphine.
• Clinical care was discontinued in, overall, 23.0% (n=26) of the cohort.
• They noted a small number of pregnancy losses (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7–95.9).