Postpartum Contraception Provision and Opioid Use During Pregnancy

Background: Opioid use and opioid use disorder (OUD) during pregnancy are significant issues in the United States; yet little is known about postpartum contraception use among these women, particularly in comparison to women who do not use opioids. This study examined the relation between opioid use during pregnancy and postpartum prescription contraception. Methods: Privately insured women with livebirths from 2011 to 2017 were identified using MarketScan, a database of paid health insurance claims. Provision of prescription contraception within 60 days postpartum was assessed among women who maintained continuous health insurance coverage through pregnancy and the first 60 days postpartum (n=1,291,352). A subset of women who used opioids during pregnancy were linked with infant records (n=63,897) to examine the impact of infant outcomes on contraceptive provision within 60 days postpartum. Contraceptive provision within 365 days postpartum was assessed among women with a livebirth from 2011 to 2016 and who maintained health insurance coverage through pregnancy and for any duration postpartum, up to 365 days (n=1,270,832). Multivariable logistic and multinomial regression models estimated the odds and relative risk ratio (RRR) of contraceptive provision by 60 days postpartum. Multivariable Cox Proportional Hazards models assessed the hazard of contraceptive provision within 365 days postpartum. Results: Women with non-chronic and chronic prescription opioid use were more likely to receive postpartum prescription contraception than women with no opioid use; women with OUD were less likely to receive contraception. Women who used opioids had a higher RRR of sterilization verses no prescription method compared to women with no opioid use. Among women provided contraception, women with chronic prescription opioid use had the shortest time to provision and women with OUD had the longest time to provision. Increasing infant hospital length of stay was associated with decreased provision of contraception by 60 days postpartum among women who used opioids. Conclusions: Opioid use during pregnancy was associated with different levels of contraceptive provision overall and by method type across the postpartum period compared to women with no opioid use. This study highlights the need to address disparities in postpartum contraceptive provision among women who use opioids, particularly for women with OUD. Advisor: Donna Strobino, Ph