Increasing access to immediate postpartum contraceptive implants: a prospective clinical trial among patients with opioid use disorder

Abstract

Objective

To evaluate the effects of increased access to immediate postpartum contraceptive implants (IPI) on repeat pregnancy and contraceptive use rates among patients with opioid use disorder (OUD).

Materials and Methods

Between 2016 and 2018, 194 postpartum patients with OUD were offered the option of IPI placement at an institution with limited immediate postpartum long-acting reversible contraception availability and followed for one-year postpartum. Differences in pregnancy rates between participants who did and did not choose IPI were examined using logistic regression with inverse probability of treatment weighting from propensity scores accounting for differences between the two groups.

Results

Among 194 participants, 96 (49.5%) chose an IPI and 98 (50.5%) chose an alternative method or no contraception (non-IPI). Among IPI participants, 76 (80.9%) continued to use their implant at one-year postpartum. Overall, 19 participants had a repeat pregnancy and 11 (57.9%) were unintended. In multivariable analyses, repeat pregnancy was more likely among those who did not choose IPI (OR 9.90; 95% CI 3.58–27.03) than those who did. Participants with OUD and who used alcohol (11.66; 1.38, 98.20) or cocaine (2.72; 1.23, 5.99) during pregnancy were more likely to choose IPI. Participants who were married (0.28; 0.09, 0.89), engaged in OUD treatment prior to pregnancy (0.48; 0.25, 0.93), and happier when they found out about their pregnancy (0.87; 0.77, 0.98) were less likely to choose IPI.

Conclusion

Offering patients with OUD the option of IPI is associated with high utilisation and continuation rates, and low rates of repeat pregnancy within one-year postpartum.

摘要

目的：评估增加产后即时皮下埋植避孕剂（IPI）的获取对阿片类物质使用障碍（OUD）者再次妊娠率和避孕药使用率的影响。

材料和方法：2016年至2018年期间, 在一个产后长效可逆避孕措施选择有限的机构, 为194名产后OUD患者提供了IPI安置的选择, 并在产后一年内进行跟踪。使用Logistic回归法检验了选择和不选择IPI的参与者之间的妊娠率差异, 并根据倾向评分对治疗权重进行了反概率分析, 以解释两组之间的差异。

结果：在194名参与者中, 96人（49.5%）选择了IPI, 98人（50.5%）选择了替代方法或不避孕（非IPI）。在IPI参与者中, 76人（80.9%）在产后一年继续选择埋植剂。总的来说, 19名参与者中再次妊娠, 11人（57.9%）是意外妊娠。在多变量分析中, 不选择IPI的人比选择IPI的人更容易再次妊娠（OR 9.90；95% CI 3.58-27.03）。患有OUD并在怀孕期间使用酒精（11.66；1.38, 98.20）或可卡因（2.72；1.23, 5.99）的参与者更可能选择IPI。已婚（0.28；0.09, 0.89）、在妊娠前使用过OUD治疗（0.48；0.25, 0.93）, 以及在发现妊娠时比较高兴（0.87；0.77, 0.98）的参与者不太可能选择IPI。

结论：向OUD患者提供IPI选择与高使用率和高续用率以及产后一年内低重复妊娠率相关。

Keywords:

• Opioid use disorder
• postpartum
• contraception
• long-acting reversible contraception

Acknowledgments

The authors thank Christine Rause, MSN, CRNP, Melissa Byrne, MSN, CRNP, MPH, and Jessica Tarleton, MD, MPH for their assistance with implant insertion.

Disclosure statement

Dr. Krans is an investigator on grants to Magee-Womens Research Institute from the National Institutes of Health and Gilead outside of the submitted work. Dr. Chen receives research support from Medicines360 and Sebela, managed by Magee-Womens Research Institute. The other authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by an investigator-initiated award from Merck Sharpe & Dohme Corporation, a division of Merck & Co., Inc., Kenilworth, NJ USA.