Association of Opioid Use Disorder and Provision of Highly Effective Inpatient Postpartum Contraception

Tani Malhotra,1,2 David Sheyn,3 Kavita Arora1,4 1Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA; 2Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 3Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 4Department of Obstetrics and Gynecology, University of North Carolina – Chapel Hill, Chapel Hill, NC, USACorrespondence: Tani Malhotra, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA, Tel +1 216-778-4444, Email TaniMalhotra@gmail.comAbstract: We sought to examine the rates of the inpatient provision of postpartum long-acting and permanent methods (IPP LAPM) of contraception in patients with opioid use disorder (OUD). This is a retrospective cross-sectional regression analysis of the National Inpatient Sample between 2012 and 2016. Patients with a diagnosis of OUD that delivered and received postpartum permanent contraception or long acting reversible contraception placement during the same hospitalization were identified. Regression analyses were performed to identify the demographic and clinical factors associated with long acting and permanent contraception method utilization. Of the 22,294 patients with OUD who delivered during the study period, 2291 (10.3%) received IPP LAPM. The majority of patients (1989) (86.6%) with OUD who chose inpatient provision of long acting or permanent methods after delivery received permanent contraception. After adjusting for covariates, patients with OUD had an overall decreased probability of receiving IPP LAPM (aOR=0.89, 95% CI: 0.85– 0.95), decreased probability of receiving permanent contraception (aOR: 0.82, 95% CI: 0.78– 0.88), but an increased probability of receiving long-acting reversible contraception (aOR: 1.29, 95% CI: 1.04– 1.60) compared to patients without OUD. This study highlights the continued need to ensure appropriate measures (such as antepartum contraceptive counseling, availability of access to inpatient LAPM, and removal of Medicaid policy barriers to permanent contraception) are in place so that the contraceptive needs of patients with OUD are fulfilled.Keywords: opioid use disorder, substance use disorder, pregnancy, disparities, contraception, postpartum, intrauterine device, implant, permanent contraception, surgical contraceptio