Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder

Jennifer K Bello; Kevin Y Xu; Joanne Salas; Bronwyn S Bedrick; Richard A Grucza

doi:10.1007/s11606-024-08689-8

Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder

J Gen Intern Med. 2024 Feb 29. doi: 10.1007/s11606-024-08689-8. Online ahead of print.

Authors

Jennifer K Bello^#¹, Kevin Y Xu^#², Joanne Salas³, Bronwyn S Bedrick⁴, Richard A Grucza^{5

3}

Affiliations

¹ Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA. jennifer.bellokottenstette@health.slu.edu.
² Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
³ Advanced Health Data Institute, Department of Health and Outcomes Research, Saint Louis University, St. Louis, MO, USA.
⁴ Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.

^# Contributed equally.

PMID: 38424347
DOI: 10.1007/s11606-024-08689-8

Abstract

Background: Treatment-seeking people with opioid use disorder (OUD) who are capable of pregnancy need accurate information about the potential impact of medication to treat OUD (MOUD) on fertility to make informed choices about treatment that are consistent with their reproductive wishes. There is a dearth of research on fertility associated with MOUD receipt in birthing people with OUD.

Objective: To estimate the association between treatment with MOUD and odds of conception among birthing people using national administrative claims.

Design: Retrospective case-crossover study using multi-state US administrative data (2006-2016). Dates of conception were estimated from delivery dates and served as "case" days for which MOUD exposures were compared to those on all other ("control") days of insurance enrollment.

Participants: Treatment-seeking people with OUD with a delivery during the observation period.

Main measures: Odds ratios for conception from within-person fixed effects models were modeled as a function of exposure to MOUD (buprenorphine, methadone, extended-release depot naltrexone, or oral naltrexone) using conditional logistic regression.

Key results: A total of 21,928 births among 19,133 people with OUD were identified. In the sample, 5873 people received buprenorphine, 1825 methadone, 486 extended-release naltrexone, and 714 oral naltrexone. Participants could receive more than one type of MOUD. Mean age was 28.2 years (SD = 2.2; range = 16-45), with 76.2% having Medicaid. vs. commercial insurance. Compared to no MOUD, periods of methadone (aOR = 0.55 [95% CI = 0.48-0.63]) or buprenorphine receipt (aOR = 0.84 [0.77-0.91]) were associated with fewer conceptions. Treatment periods with extended-release depot naltrexone compared to no medication were associated with higher odds of conception (aOR = 1.75 [1.22-2.50]) and there was no significant difference in conception with oral naltrexone (aOR = 1.02 [0.67-1.54]).

Conclusions: The association between MOUD and odds of conception among birthing people varied by type of MOUD, with extended-release naltrexone associated with higher odds of conceiving compared to no treatment. Clinical studies are urgently needed to investigate these findings further.

Keywords: buprenorphine; fertility; methadone; naltrexone; opioid use disorder; pregnancy.

Abstract

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